The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors

Abstract

Study Design: Literature review. Objective: To provide an overview of the recent advances in minimal access surgery (MAS) for spinal metastases. Methods: Literature review. Results: Experience gained from MAS in the trauma, degenerative and deformity settings has paved the road for MAS techniques for spinal cancer. Current MAS techniques for the treatment of spinal metastases include percutaneous instrumentation, mini-open approaches for decompression and tumor resection with or without tubular/expandable retractors and thoracoscopy/endoscopy. Cancer care requires a multidisciplinary effort and adherence to treatment algorithms facilitates decision making, ultimately improving patient outcomes. Specific algorithms exist to help guide decisions for MAS for extradural spinal metastases. One major paradigm shift has been the implementation of percutaneous stabilization for treatment of neoplastic spinal instability. Percutaneous stabilization can be enhanced with cement augmentation for increased durability and pain palliation. Unlike osteoporotic fractures, kyphoplasty and vertebroplasty are known to be effective therapies for symptomatic pathologic compression fractures as supported by high level evidence. The integration of systemic body radiation therapy for spinal metastases has eliminated the need for aggressive tumor resection allowing implementation of MAS epidural tumor decompression via tubular or expandable retractors and preliminary data exist regarding laser interstitial thermal therapy and radiofrequency ablation for tumor control. Neuronavigation and robotic systems offer increased precision, facilitating the role of MAS for spinal metastases. Conclusions: MAS has a significant role in the treatment of spinal metastases. This review highlights the current utilization of minimally invasive surgical strategies for treatment of spinal metastases.

Separation surgery for metastatic epidural spinal cord compression: comparison of a minimally invasive versus open approach

“…22 Moreinvasive surgeries that carry increased risk of complications and surgical morbidity, such as staged thoracotomy or retroperitoneal approaches, corpectomies with anterior column reconstruction, or spondylectomies with wide excision, are now less frequently utilized. 10,23,24 Because of the advancements in technique, including less local tissue disruption and a potentially faster rate of recovery while maintaining safe targets for high-dose radiotherapy, MIS has become the new state-of-the-art treatment for MESCC. 8,25,26 In this study, we have demonstrated that, although there was a trend toward faster time to starting radiation treatment in the MIS group, there were similar postoperative radiotherapy doses among both groups, with no increased rate of local recurrence and no occurrences of hardware failure.…”

“…Separation surgery-re-creation of a minimum amount of space of 2-to 3-mm margins between the tumor and the spinal cord to allow for safe postoperative SRS-avoids the morbidity of extensive tumor debulking and reconstruction. [8][9][10] This strategy has allowed for the exploration of minimally invasive surgery (MIS) approaches with the goals of reducing blood loss, muscle disruption, pain, and recovery time. 11 Systematic reviews by Pennington et al and Zuckerman et al exploring MIS for spinal metastases found that patients treated with MIS tended to achieve these goals with fewer complications.…”

Patient Participation With a Mobile Phone Application for Objective Activity Assessment Before and After Spinal Fusion

“…Advancing surgical techniques and innovative devices have revolutionized spine surgery within the past decade [ 1 ]. Many novel technologies, such as robotic spine surgery, microendoscopy-assisted procedures, and machine learning/artificial intelligence for procedural analysis, have allowed surgeons to evolve towards more minimally invasive approaches [ 2 , 3 ]. These advancements permit smaller incisions, less blood loss, and, ultimately, a quicker return to daily activities [ 4 , 5 ].…”

Intraoperative blood loss in oncological spine surgery

“…7,8 Minimally invasive techniques have been shown to significantly reduce not only the length of hospitalization, but also the perioperative morbidity and intraoperative blood loss. [9][10][11] Because the surgical treatment of both spinal and extraspinal metastases is often associated with considerable blood loss (mean 1200 ml, up to 6000 ml), intraoperative and perioperative bleeding management has increased significantly in importance and became a pivotal topic, 12 especially when minimally invasive techniques alone are not sufficient to regain, e.g., spinal alignment due to vertebral collapse and hyperkyphosis.Numerous factors, such as tumor histology, type of surgical procedure, and duration of surgery, are known to influence the amount of intraoperative blood loss. 13 However, anesthesiology parameters, percentage of osseous ABBREVIATIONS ABT = allogeneic blood transfusion; ASA = American Society of Anesthesiologists; ESCC = epidural spinal cord compression; KW = Kruskal-Wallis; MET = metabolic equivalent of task; RBC = red blood cell.…”

“…7,8 Minimally invasive techniques have been shown to significantly reduce not only the length of hospitalization, but also the perioperative morbidity and intraoperative blood loss. [9][10][11] Because the surgical treatment of both spinal and extraspinal metastases is often associated with considerable blood loss (mean 1200 ml, up to 6000 ml), intraoperative and perioperative bleeding management has increased significantly in importance and became a pivotal topic, 12 especially when minimally invasive techniques alone are not sufficient to regain, e.g., spinal alignment due to vertebral collapse and hyperkyphosis.…”