Comparison between minimally invasive spine stabilization with and without posterior decompression for the management of spinal metastases: a retrospective cohort study

Abstract

BackgroundPosterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. However, the indication for addition of posterior decompression have not been examined. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression.MethodsThe subjects were 40 patients who underwent MISt using percutaneous pedicle screws for metastatic spinal tumor, including 20 patients treated with stabilization alone (group A) and 20 patients with added posterior decompression (group B). We analyzed baseline characteristics, postoperative survival time, and perioperative factors such as neurological outcomes, Barthel Index, VAS, and rate of discharge to home.ResultsThe mean ages were 70 and 66 years old (P = 0.06), the mean revised Tokuhashi scores were 7.2 and 5.8 (P = 0.1), the mean spinal instability neoplastic scores (SINS) were 10.5 and 9.0 (P = 0.04), and the mean Barthel Index for ADL were 65.5 and 41.0 (P = 0.06) in groups A and B, respectively. The median postoperative survival time did not differ significantly between groups A and B (12.0 vs. 6.0 months, P = 0.09). Patients in group A had a significantly shorter operation time (166 vs. 232 min, P = 0.004) and lower intraoperative blood loss (120 vs. 478 mL, P < 0.001). Postoperative paralysis (P = 0.1), paralysis improvement rate (P = 0.09), postoperative Barthel Index (P = 0.06), and postoperative VAS (P = 0.6) did not differ significantly between the groups. The modified Frankel classification improved from D1 or D2 before surgery to D3 or E after surgery in 4 of 10 cases (40%) in group A and 8 of 8 patients (100%) in group B (P = 0.01). Significantly more patients were discharged to home in group A (P = 0.02), whereas significantly more patients died in the hospital in group B (P = 0.02).ConclusionsPatients treated without decompression had a shorter operation time, less blood loss, a higher rate of discharge to home, and lower in-hospital mortality, indicating a procedure with lower invasiveness. MISt without decompression is advantageous for patients with D3 or milder paralysis, but decompression is necessary for patients with D2 or severer paralysis.

Impairment-driven cancer rehabilitation in patients with neoplastic spinal cord compression using minimally invasive spine stabilization

“…Previously, Uei et al reported 40 patients with spinal metastasis treated with MISt. They focused on the surgical technique, comparing prognosis with and without posterior decompression [30]. They concluded that MISt without decompression is advantageous for certain patients; however, they did not perform statistical analysis of the Barthel index (BI) scores between before and after surgery.…”

Clinical Results of Minimally Invasive Spine Stabilization for the Management of Metastatic Spinal Tumors Based on the Epidural Spinal Cord Compression Scale

“…Therefore, surgical stress by palliative surgery has recently been minimized [ 12 – 21 ]. Compared with conventional posterior decompression fusion surgery, the surgical wound from MISt using PPS is small, the operative time is short, intraoperative blood loss is low, and the wound heals rapidly, facilitating adjuvant therapy early after surgery [ 15 , 16 , 23 ]. In the present study, the median survival time after surgery determined using the Kaplan-Meier method was 12.0 months in group A (95% CI: 9.1-14.8) and 15.0 months (95% CI: 3.9-26.0) in group B (P=0.60).…”

“…Of the patients who underwent MISt for metastatic spinal tumors, for those without posterior decompression, the operative time is shorter and blood loss is lower, further minimizing the invasiveness [ 16 ]. In the present study, posterior decompression was performed for 12 patients (35.3%) in group A, which was significantly fewer (P=0.006), but the operative time (P=0.24) and blood loss (P=0.19) were not significantly different, albeit slightly lower.…”

“…Most metastatic spinal tumors are cancer metastasis, a systemic disease for which treatment is limited [ 1 – 4 ]. Evaluation of the outcome of low-invasive palliative surgery for metastatic spinal tumors has focused only on the technical aspects, surgical stress, and short-term improvement of paralysis, and the postoperative survival time, ADL, and quality of life (QOL) were evaluated in only a few studies [ 15 , 16 , 18 , 19 , 23 ]. To maintain the QOL of cancer patients, it is important to continue adjuvant therapy, such as chemotherapy and radiotherapy, after surgery.…”

“…We performed a retrospective review using prospectively collected data from 100 consecutive patients who underwent palliative surgery for metastatic spinal tumors between January 2012 and December 2017 at our institution. MISt with PPS for metastatic spinal tumors [ 15 , 16 , 23 ] was indicated for intractable pain due to spinal instability or threat of instability defined by the spinal instability neoplastic score (SINS) [ 24 ], spinal paralysis, such as any change in the motor examination, or radiation-resistant cancer such as kidney cancer or thyroid cancer. We excluded patients for whom total en bloc spondylectomy was indicated for spinal levels at the occipital to the cervical region; it was impossible to confirm the pedicle of the vertebral arch under fluoroscopy or impossible to insert PPS who were treatable with balloon kyphoplasty, who were treatable with posterior decompression alone, or who had a life expectancy less than 6 months and were responsive to narcotic analgesics or markedly responsive to radiotherapy, poor general condition (Karnofsky performance status 3 or poorer), or a reduced will to live.…”