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Minimal Access vs. Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One-Center Randomized
SØren Schmidt Morgen1, Lars Valentin Hansen2, Ture Karbo2
1Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark s@smorgen.dk.
Background/Aim:
We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC).
Patients And Methods:
A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing.
Results:
The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing.
Conclusion:
The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.
Insights
Minimally access spine surgery (MASS) reduces blood loss in metastatic spinal cord compression (MSCC) patients compared to open surgery (OS). However, MASS requires a longer operative time, with no significant differences in revision surgery or wound healing.
Area of Science:
- Neurosurgery
- Oncology
- Surgical Innovation
Background:
- Metastatic spinal cord compression (MSCC) poses significant challenges in patient management.
- Evaluating surgical approaches for MSCC is crucial for optimizing patient outcomes.
- Minimally invasive techniques are increasingly explored to improve surgical safety and efficacy.
Purpose of the Study:
- To compare the morbidity of minimally access spine surgery (MASS) versus open surgery (OS) in patients with MSCC.
- To assess key peri-operative outcomes including blood loss, operation time, re-operations, and wound healing.
- To provide evidence-based insights for surgical decision-making in MSCC.
Main Methods:
- A randomized controlled trial involving 49 patients diagnosed with MSCC.
- Comparison of peri-operative blood loss (L) and operation time (min) between MASS and OS groups.
- Assessment of secondary outcomes: re-operations and prolonged wound healing.
Main Results:
- MASS group demonstrated significantly lower peri-operative blood loss (0.175L) compared to the OS group (0.500L) (p=0.002).
- MASS procedures had a longer median operation time (142 min) than OS (103 min) (p=0.001).
- No statistically significant differences were observed between MASS and OS regarding revision surgery or delayed wound healing.
Conclusions:
- Minimally access spine surgery (MASS) is associated with reduced blood loss in MSCC patients compared to open surgery (OS).
- The MASS technique requires a longer operative duration than OS for MSCC.
- MASS and OS showed comparable rates of revision surgery and wound healing complications in this cohort.
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