Abstract
AB075. When would minimally invasive spinal surgery not be preferable for metastatic spine disease?—a narrative review
Si Jian Hui1, Naresh Kumar1, Jiong Hao Tan1, Sahil Athia2, Shahid Ali3, Seok Woo Kim4
1University Spine Centre, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore;
2Royal College of Surgeons, Dublin, Ireland;
3King Edward Medical University, Lahore, Pakistan;
4Spine Center, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
Correspondence to: Naresh Kumar, MBBS, M.S. (Orth), D.N.B. (Orth), FRCS (Trauma and Orth), DM (Orth and Spinal Surgery). University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Kent Ridge Rd., Singapore 119228, Singapore. Email: dosksn@nus.edu.sg.
Background: Metastatic spine tumour surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment. However, advancements in MSTS in recent years has resulted in a current paradigm shift towards today’s gold standard of minimally invasive spinal surgery (MISS) and early adjuvant RT in treating MSD patients. Nonetheless, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations for not using MISS in MSD in today’s clinical context. We aim to bridge the gap where OSS should be considered with caution and highlight situations where MISS is preferable using the available literature and personal experience.
Methods: This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library and Scopus databases through August 31, 2023. Inclusion criteria for the review were studies with discussion on the type of surgery in MSTS.
Results: A total of 52 studies were included in this review. We discussed various advantages and situations appropriate for MISS for MSD in today’s clinical context. Nonetheless, there are still various unique circumstances in which MISS may be less suitable. MISS is less feasible in patients of paediatric profile, having short stature or having had previous surgery at the level of operation. Occipitocervical and cervicothoracic location of vertebrae metastasis also makes MISS less feasible due to access and imaging difficulty. MISS for tumours which are hypersclerotic and hypervascular can also result in more difficulty for cannulation of MISS probes as well as control of bleeding respectively, and hence will be less encouraged in the above settings.
Conclusions: Our review will be the first to discuss circumstances in which MISS is less applicable, despite the advantages it may confer over traditional OSS. MSTS should be individualized to the patient, depending on the experience of the surgeon. OSS is still a time-tested approach that holds weight in MSTS and should be readily utilized depending on the clinical situation.
Keywords: Metastatic spine tumour surgery (MSTS); minimally invasive; open surgery
Acknowledgments
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab075/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Cite this abstract as: Hui SJ, Kumar N, Tan JH, Athia S, Ali S, Kim SW. AB075. When would minimally invasive spinal surgery not be preferable for metastatic spine disease?—a narrative review. Chin Clin Oncol 2024;13(Suppl 1):AB075. doi: 10.21037/cco-24-ab075
