Minimally invasive surgery for spinal metastases: Principles, techniques, and outcomes

Abstract

The incidence of metastatic spine disease (MSD) is on the rise and is currently present in 70% of patients presenting with systemic cancer. The majority of patients with MSD present with clinical symptoms such as neurological deficit, pathological fracture causing pain and spinal instability. Management of MSD is a multidisciplinary endeavor that involves surgery, radiotherapy (RT), and chemotherapy. The conventional open spine surgery approach has evolved into a less invasive surgery model categorized as minimally invasive spine surgery (MISS) or minimal access spine surgery. This evolution was brought about to address the complications associated with open surgery such as longer hospital stays and wound-related problems. MISS has been now widely explored in MSD due to lower wound-related complications, decreasing operative time, less neurological complications, and shorter hospital stays. Decompression and stabilization still remain the core concepts in MISS. Kyphoplasty/vertebroplasty, percutaneous pedicle screw fixation, separation surgery, and radiofrequency ablation are some of the minimally invasive techniques and procedures for surgical management of MSD. MISS is used in conjunction with other modern techniques like intraoperative neuromonitoring to help identify any adverse neurological events. MIS techniques will evolve with time, extending their application for the management of hypervascular tumors with significant anterior cord compression and recurrent tumors in which the open surgery currently remains the choice of approach.