Endoscopic surgery for thoracolumbar spinal metastases: a technical case series
Melissa Kwak1, Waldo Solis2, Yingda Li1,3
11Department of Neurosurgery, Westmead Hospital, Sydney.
Objective:
With its favorable profile of enhanced recovery and a reduced perioperative footprint, there is growing evidence for endoscopic spine surgery (ESS) in the management of thoracolumbar spinal malignancies. The aim of this study was to explore the conceptual framework of the endoscopic benefit zone in the management of metastatic spinal disease, and present an Australasian-first technical case series, establishing its feasibility and outcomes in this cohort.
Methods:
Between 2021 and 2026, 7 patients (4 female, mean age 56) who were diagnosed with spinal metastases underwent ESS as part of multidisciplinary management. Patient selection criteria, cohort demographics, anatomical factors, and postoperative outcomes were assessed, and technical considerations of endoscopic surgical approaches were overviewed. Five patients received percutaneous posterior fixation (4 with cement augmentation), and 3 of the 4 patients with disease involving thoracic levels underwent preoperative angioembolization.
Results:
All patients successfully underwent endoscopic surgical management without conversion to an open procedure. Effective decompression, separation, and rapid symptomatic improvement were achieved in all cases, confirmed radiologically in cases of spinal cord compression, with no surgical complications recorded. Six of 7 patients were mobilized within 24 hours of surgery, and adjuvant radiation and/or systemic therapy was promptly commenced. Ambulatory status was maintained or improved in all patients during follow-up.
Conclusions:
This Australasian-first case series demonstrates that ESS is a feasible adjunct in the management of thoracolumbar spinal metastases in selected patients, achieving effective decompression and separation, and synergizing with other minimally invasive techniques such as percutaneous fixation and angioembolization. The endoscopic anatomical corridors of the thoracolumbar spine allow direct access to pathology with preservation of normal structures, thus enabling rapid recovery and prompt commencement of adjuvant therapies.