Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.

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. In recent years, an increasing number of cancer patients develop symptomatic metastatic spinal cord compression (MSCC). This is most likely a result of the advancement in cancer treatment and prolonged survival among cancer patients in general (1, 2). The optimal treatment for MSCC patients is considered to be surgery in combination with radiation therapy (3, 4). However, the majority of patients are not recommended surgical treatment due to poor health and relatively short survival time, which means that they cannot withstand large surgical procedures (5, 6). Minimally access spine surgery (MASS) is considered less morbid than open surgery (OS), and results in fewer wound complications and less bleeding. The existing evidence for bleeding in minimal versus open surgery from observational studies is gathered in two recently published reviews by Pennington and colleagues and by Lu and colleagues. The conclusions were that "The overall quality of evidence currently available is low-all evidence is currently class III or IV" (7, 8). With this clinical trial we aimed to examine the perioperative bleeding, surgery time and number of revisions of MASS compared with conventional OS in the treatment of patients with MSCC. The hypothesis of the study was that MASS results in significantly less blood loss, shorter surgery time and fewer revisions when compared to open surgery. Patients and Methods Study population. The study includes MSCC patients admitted to Rigshospitalet, Denmark from January 1 st , 2014 to January 1 st , 2017. The hospital serves a population of 2.3 million people from the eastern part of Denmark. The MSCC diagnosis was based on magnetic resonance imaging (MRI) in combination with clinical symptoms such as back pain and/or neurological impairment. Patients with MSCC between T5 to L3 where included. Patients with Tokuhashi score ≤4, in need of sacral or iliosacral instrumentation, and patients who were candidates for a corpectomy were excluded. All patients were included in the study at referral and information regarding age, sex, primary oncolog...

Level III.