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Minimally Invasive Stabilization Versus Open Surgery for Spinal Metastases: A Retrospective Study Utilizing

Kamil Krystkiewicz1, Aleksander Kowal1, Agata Krajniak1

  • 1Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, 93-513 Lodz, Poland.

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|February 27, 2026
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Summary

Minimally invasive spinal stabilization (MISS) showed lower wound complications than open posterior stabilization (OPEN) for spinal metastases. While not statistically significant, MISS also trended towards shorter hospital stays.

Keywords:
metastatic spine diseaseminimally invasive spine surgerysurgery complicationssurgical site infection

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Oncology

Background:

  • Minimally invasive spinal stabilization (MISS) is increasingly adopted for metastatic spine surgery.
  • Comparative evidence between MISS and open posterior stabilization (OPEN) is limited, particularly regarding perioperative outcomes.
  • Wound-related morbidity is a critical concern in spinal stabilization procedures.

Purpose of the Study:

  • To compare perioperative outcomes between MISS and OPEN posterior stabilization in patients with spinal metastases.
  • To specifically evaluate and compare wound-related morbidity between the two surgical approaches.
  • To assess secondary outcomes including estimated blood loss and length of stay.

Main Methods:

  • Retrospective single-center cohort study of 71 patients with spinal metastases undergoing posterior stabilization.
  • Patients were divided into MISS (n=45) and OPEN (n=26) groups.
  • Primary endpoint was wound-healing disorder; nonparametric exact tests, adjusted analyses, and propensity score matching (IPTW) were used for comparison.

Main Results:

  • Wound-healing disorders were significantly lower in the MISS group (6.7%) compared to the OPEN group (30.8%) (p=0.014).
  • Surgical site infection (SSI) rates were also lower in MISS (2.2%) versus OPEN (19.2%) (p=0.022).
  • Estimated blood loss was similar between groups; length of stay tended to be shorter in MISS but lacked statistical significance.

Conclusions:

  • Open posterior stabilization was associated with higher unadjusted wound-related morbidity compared to minimally invasive spinal stabilization in metastatic spine surgery.
  • Blood loss did not significantly differ between the two surgical approaches.
  • While MISS showed a trend towards shorter hospital stays, further underpowered studies are needed for definitive conclusions.