title: Metastatic Spine Tumor Surgery: A Comparative Study of Minimally Invasive Approach Using Percutaneous Pedicle Screws Fixation Versus Open Approach.
abstract: METHODS
  Prospective cohort study.
  
  
  BACKGROUND
  Minimally invasive spinal surgery (MISS) has been gaining recognition in patients with metastatic spine disease (MSD). The advantages are reduction in blood loss, hospital stay, and postoperative morbidity. Most of the studies were case series with very few comparing the outcomes of MISS to open approaches.
  
  
  OBJECTIVE
  To evaluate and compare the clinical and perioperative outcomes of MISS versus open approach in patients with symptomatic MSD, who underwent posterior spinal stabilization and/or decompression.
  
  
  METHODS
  Our study included 45 MSD patients; 27 managed by MISS and 18 by open approach. All patients had MSD presenting with symptoms of neurological deficit, spinal instability, or both. Preoperative, intraoperative, and postoperative data were collected for comparison of the 2 approaches. All patients were followed up until the end of study period (maximum up to 4 years from time of surgery) or till their demise. The clinical outcome measures were pain control, neurological and functional status, whereas perioperative outcomes were blood loss, operative time, length of hospital stay, and time taken to initiate radiotherapy/chemotherapy after index surgery.
  
  
  RESULTS
  Majority of patients in both groups showed improvement in pain, neurological status, independent ambulation, and ECOG score in the postoperative period with no significant differences between the 2 groups. There was a significant reduction in intraoperative blood loss (621 mL less, P<0.001) in the MISS group. The average time to initiate radiotherapy after surgery was 13 days (range, 12-16 d) in MISS and 24 days (range, 16-40 d) in the open group. This difference was statistically significant (P<0.001). Operative time and duration of hospital stay were also favorable in the MISS group, although the differences were not significant.
  
  
  CONCLUSIONS
  MISS is comparable with open approach demonstrating similar improvements in clinical outcomes, that is pain control, neurological and functional status. MISS approaches have also shown promising results due to lesser intraoperative blood loss and allowing earlier radiotherapy/chemotherapy.
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Rishi
authors.initials: R
authors.lastname: Malhotra
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Maharajan
authors.forename: Aye S
authors.initials: AS
authors.lastname: Zaw
authors.forename: Pang Hung
authors.initials: PH
authors.lastname: Wu
authors.forename: Milindu C
authors.initials: MC
authors.lastname: Makandura
authors.forename: Gabriel Ka
authors.initials: GK
authors.lastname: Po Liu
authors.forename: Joseph
authors.initials: J
authors.lastname: Thambiah
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D065289:Pedicle Screws; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome