Abstract
Although increasingly aggressive decompression and resection methods have resulted in improved outcomes for patients with metastatic spine disease, these aggressive surgeries are not feasible for patients with numerous comorbid conditions. Such patients stand to benefit from management via minimally invasive spine surgery (MIS), given its association with decreased perioperative morbidity. We performed a systematic review of literature with the goal of evaluating the clinical efficacy and safety of MIS in the setting of metastatic spine disease. Results suggest that MIS is an efficacious means of achieving neurological improvement and alleviating pain. In addition, data suggests that MIS offers decreased blood loss, operative time, and complication rates in comparison to standard open spine surgery. However, due to the paucity of studies and low class of available evidence, the ability to draw comprehensive conclusions is limited. Future investigations should be conducted comparing standard surgery versus MIS in a prospective fashion.
Highlights
It is estimated that nearly 10 million people worldwide were diagnosed with cancer in 2000, with the incidence expected to increase to 15 million by 2020 [1]
Case reports are normally excluded in systematic reviews, they were included in this review due to the paucity of evidence evaluating minimally invasive spine surgery (MIS) in the setting of metastatic spine disease
The main outcomes extracted from the selected publications included mean operating time (MOT), mean blood loss (MBL), hospital length of stay (LOS), rate of neurological improvement (NI), pain alleviation rate (PA), and complication rate (CR)
Summary
It is estimated that nearly 10 million people worldwide were diagnosed with cancer in 2000, with the incidence expected to increase to 15 million by 2020 [1]. The most commonly diagnosed neoplasms are breast, lung, and prostate cancers [2, 3]. Given the predilection of the breast, prostate, and lung neoplasms to metastasize to bone, it is not surprising that spinal metastases occur in 30–90% of patients, with 10% of such patients experiencing symptomatic metastatic epidural spinal cord compression (MESCC) [4, 5]. The most common symptom at presentation is pain that can be both radicular (exaggerated by percussion or palpation) and/or mechanical (exacerbated by movement) [6, 7]. Neurological dysfunction including motor, sensory, and autonomic dysfunction is the second most common presentation modality and is indicative of metastatic epidural spinal cord compression (MESCC) [3, 8,9,10]
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