Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRIS-MA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at -35.23 minutes (95% confidence interval [CI], -73.36 to 2.91 minutes; p=0.07). Intraoperative bleeding was lower in MIS at -562.59 mL (95% CI, -776.97 to -348.20 mL; p<0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; p<0.00001). Both approaches instrumented similar numbers of levels at -0.05 levels (95% CI, -0.75 to 0.66 levels; p=0.89). We observed a decreased need for postoperative bed rest at -1.60 days (95% CI, -2.46 to -0.74 days; p=0.0003), a shorter length of stay at -3.08 days (95% CI, -4.50 to -1.66 days; p=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; p=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; p=0.57), effective rates of reducing metastasis-related pain at -0.74 (95% CI, -2.41 to 0.94; p=0.39), and comparable scores of the Tokuhashi scale at -0.52 (95% CI, -2.08 to 1.05; p=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; p=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; p=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.

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ARM designed the study, conducted statistical analyses, wrote and edited this article. ETG gathered data, conducted data analysis, and interpreted and edited this article. LCBG participated in the study design and contributed extensively to the editing and writing of this article. BVE and JRRB gathered data. CAGG participated in study conceptualization, design, analysis, and editing. EFV and JAFS participated in study conceptualization, design, gathering of data, and editing. DEHG designed the study, conducted statistical analyses, and wrote this article.

The present report describes the case of a 27-year-old male with a longstanding diagnosis of melanoma with metastatic disease treated with nivolumab, an immune checkpoint inhibitor. He presented with a chronic cough of unknown etiology, not responsive to standard of care treatment with cough suppressants. In view of this, a bronchoscopy was done, and biopsies were taken. The patient was diagnosed with eosinophilic tracheitis secondary to nivolumab. His symptoms improved with steroids and cessation of the immune checkpoint inhibitor. Prescribing physicians should be aware of these rare and potentially life-threatening toxic effects.

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