title: Comparison Between Minimally Invasive Surgery and Conventional Open Surgery for Patients With Spinal Metastasis: A Prospective Propensity Score-Matched Study.
abstract: METHODS
  Prospective propensity score-matched study.
  
  
  OBJECTIVE
  To compare the outcomes of minimal invasive surgery (MIS) and conventional open surgery for spinal metastasis patients.
  
  
  BACKGROUND
  There is lack of knowledge on whether MIS is comparable to conventional open surgery in treating spinal metastasis.
  
  
  METHODS
  Patients with spinal metastasis requiring surgery from January 2008 to December 2010 in two spine centers were recruited. The demographic, preoperative, operative, perioperative and postoperative data were collected and analyzed. Thirty MIS patients were matched with 30 open surgery patients using propensity score matching technique with a match tolerance of 0.02 based on the covariate age, tumor type, Tokuhashi score, and Tomita score.
  
  
  RESULTS
  Both groups had significant improvements in Eastern Cooperative Oncology Group (ECOG), Karnofsky scores, visual analogue scale (VAS) for pain and neurological status postoperatively. However, the difference comparing the MIS and open surgery group was not statistically significant. MIS group had significantly longer instrumented segments (5.5 ± 3.1) compared with open group (3.8 ± 1.7). Open group had significantly longer decompressed segment (1.8 ± 0.8) than MIS group (1.0 ± 1.0). Open group had significantly more blood loss (2062.1 ± 1148.0 mL) compared with MIS group (1156.0 ± 572.3 mL). More patients in the open group (76.7%) needed blood transfusions (with higher average units of blood transfused) compared with MIS group (40.0%). Fluoroscopy time was significantly longer in MIS group (116.1 ± 63.3 s) compared with open group (69.9 ± 42.6 s). Open group required longer hospitalization (21.1 ± 10.8 days) compared with MIS group (11.0 ± 5.0 days).
  
  
  CONCLUSIONS
  This study demonstrated that MIS resulted in comparable outcome to open surgery for patients with spinal metastasis but has the advantage of less blood loss, blood transfusions, and shorter hospital stay.
  
  
  METHODS
  3.
authors: OrthoCentrum Hamburg, Department of Spine Surgery, ParkklinikManhagen, Hamburg, Germany.|Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Nils
authors: N
authors: Hansen-Algenstaedt
authors: Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Mun Keong
authors: MK
authors: Kwan
authors: Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Petra
authors: P
authors: Algenstaedt
authors: Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Chee Kidd
authors: CK
authors: Chiu
authors: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Lennart
authors: L
authors: Viezens
authors: Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Teik Seng
authors: TS
authors: Chan
authors: Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Chee Kean
authors: CK
authors: Lee
authors: HUbertus Wald Tumor Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Jasmin
authors: J
authors: Wellbrock
authors: Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Chris Yin Wei
authors: CYW
authors: Chan
authors: Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Spine Surgery, Rheumaklinik Bad Bramstedt, Oskar Alexander Str, Bad Bramstedt, Hamburg, Germany.
authors: Christian
authors: C
authors: Schaefer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D010147:Pain Measurement; D019106:Postoperative Hemorrhage / Q000473:pathology; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome