A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive Versus Open Surgical Techniques in the Treatment of Spinal Metastases

Hikata, Tomohiro; Isogai, Norihiro; Shiono, Yuta; Funao, Haruki; Okada, Eijiro; Fujita, Nobuyuki; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

doi:10.1097/bsd.0000000000000460

Cited by 52 publications

(41 citation statements)

References 19 publications

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“…In a cohort study by Hikata et al, the authors compared 25 patients operated with MASS with 25 patients operated with OS. The results showed a significantly lower blood loss (340 versus 714 ml) and complication rate (3 versus 11 patients) in the MASS group (27). We found equal complication rates with 2 complications in each group, which is not in line with the study by T et al The difference in the complication rates in the study by Hikata et al was not discussed but is a very important aspect of the comparison and needs to be addressed and described further in future studies, if a difference is found (27).…”

Section: Discussionmentioning

confidence: 89%

“…Two recent systematic reviews have compared minimal access surgery with open surgery in patients suffering from MSCC (7,8). Lu et al included six cohort studies (three prospective and three retrospective) representing a total of 252 patients (19)(20)(21)(22)(23)(24). Lu et al concluded that are many surgical advantages to the use of MASS compared with OS, such as reduced blood loss and fewer complications, however, future larger cohort studies and future randomized trials are needed to validate the findings.…”

Section: Discussionmentioning

confidence: 99%

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Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

et al. 2020

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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...

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

et al. 2020

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“…Instability may occur during the surgical treatment of spinal tumors and methods requiring stabilization should be used [27][28][29]. Therefore, more aggressive surgical strategies are sometimes required in the presence of severe instability and/or deformity [30][31][32]. We performed laminoplasty in 21 of 64 intradural tumors and simple decompression in 42 tumors, while one was decompressed with posterior stabilization.…”

Section: Discussionmentioning

confidence: 99%

Spinal tümörler nedeniyle ameliyat edilen 101 hastanın retrospektif kohort analizi: Tek merkez deneyimi

Kitiş

Papaker

2020

Archives of Clinical and Experimental Medicine

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Aim: To evaluate the clinical and surgical outcomes of the spinal tumors operated in our clinic in order to provide an overview of the treatment strategies and outcomes of spinal tumors with the literature. Methods: We retrospectively reviewed 101 spinal tumors patients who underwent microsurgical resection at our institution between January 2015 and January 2020. Data were collected consisting of the patients' clinics, demographic information, imaging methods, surgical approaches, neuropathological diagnosis, postoperative follow-up and complications, and postoperative neurological statuses. Frankel skore was used to assess neurological status of patients. Results: 47 male and 54 female patients were followed-up for a mean period of 14.2 months. Intradural extramedullary (51.5%), extradural (36.6%) and intramedullary tumors (11.9%) were seen, respectively. The most common localization was thoracic (n=47), followed by lomber region (n=26). The most frequent histopathological diagnosis was schwannoma (n=27), meningioma (n=19), metastasis (n=19), ependymoma (n=11). According to the Frankel Scale, there was a decrease in the grades of two cases, an increase in the grades of 26 cases and no change in the grades of 73 cases. During follow-up with magnetic resonance imaging, it was observed that there were residual tumors, recurrence, and progression in 32.7%, 5.9% and 5.9% of the cases, respectively. Conclusion: Despite the developing preoperative diagnostic methods, technological developments in peroperative tools and equipment, and the development of surgical techniques, the preoperative neurological status remains the strongest predictor of postoperative function for spinal tumors. It is also important to determine the recurrence and progression rates of early magnetic resonance imaging examinations performed in patients during postoperative follow-up.

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“…Осложнения могут возникнуть у 25% пациентов, перенесших операцию по поводу метастазов в позвоночнике, наиболее распространенной из которых является раневая инфекция [11,15,49,50]. Ожидаемая продолжительность жизни обычно определяется общей степенью метастатического заболевания и, следовательно, для того, чтобы операция приносила пользу, хирургическое вмешательство должно улучшать качество жизни.…”

Section: рис 3 классификация Weinsteinunclassified

Review of Classifications and Scoring Systems for Metastatic Spine Tumors Used in Surgical Treatment

Korzh¹,

Kutsenko²,

Perfiliev³

et al. 2020

Ukr. ž. med. bìol. sportu

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It is known that metastases in the spine are detected in more than 70% of cancer patients, and in 10% of such patients, compression of nerve structures and severe neurological disorders develop. The role of surgery for metastatic tumors of the spine is in the focus of attention, since the operation can improve mechanical stability, decompress nerve structures and reduce the intensity of pain. However, what role the operation plays in increasing life expectancy and how to correctly assess the results of treatment remains controversial and the opinions of specialists are controversial, since the assessment is often made by oncologists, but it is the surgeon who more fully evaluates the potential risks and benefits of surgical interventions. Therefore, it is important for surgeons to understand what prognostic factors affect the quality and duration of life. This article presents the most cited classifications and assessments before 2009, as well as all classifications and assessments obtained after 2010 regarding metastatic lesions of the spine, as well as classifications used to develop treatment tactics obtained from the electronic databases PubMed, MEDLINE, articles, monographs, abstracts, dissertations and other sources of scientific and medical information. 57 main publications with II and III levels of evidence were selected, 6 classifications and 24 rating scales were considered. In order to construct the necessary tactics of the surgical strategy, the classification / assessment methods were divided into anatomical classification / assessment methods, neurological symptom / instability assessment methods, and assessment systems for predicting life expectancy. The study showed that in the surgical treatment of metastatic tumors of the spine, it is important to use the same rating scales and classifications to select indications and assess the results of surgical treatment, as well as to achieve meaningful comparisons between published series. Conclusion. The classifications and rating scales used for metastatic lesions of the spine do not fully reflect the type of surgical treatment: there is no algorithm for restoring the support ability of the spine, which is very important for this category of patients

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A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive Versus Open Surgical Techniques in the Treatment of Spinal Metastases

Abstract: Level 3.

Cited by 52 publications

References 19 publications

Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

Minimal Accessvs.Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One–Center Randomized Controlled Trial

Spinal tümörler nedeniyle ameliyat edilen 101 hastanın retrospektif kohort analizi: Tek merkez deneyimi

Review of Classifications and Scoring Systems for Metastatic Spine Tumors Used in Surgical Treatment

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