title: A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive Versus Open Surgical Techniques in the Treatment of Spinal Metastases.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  This study was conducted to assess the invasiveness, efficacy, and safety of minimally invasive spine stabilization (MISt) for metastatic spinal tumor patients with short life expectancy.
  
  
  BACKGROUND
  Conventional open surgery for metastatic spinal tumors has the disadvantages of significant blood loss, potential infection, damage to back muscles, and extended hospital stays. The minimally invasive spine surgery has changed the treatment of metastatic spinal tumors radically and fundamentally.
  
  
  METHODS
  We retrospectively reviewed data from 50 consecutive patients registered with the Keio Spine Research Group (KSRG) who underwent posterior palliative surgery for metastatic spinal tumors from January 2009 to June 2015. Of these, 25 patients underwent MISt surgery (M group), and 25 underwent conventional open surgery (C group). The patients were assessed by demographic data, surgical invasiveness, complications, pain improvement, and neurological recovery.
  
  
  RESULTS
  The 2 groups did not differ significantly in baseline characteristics. The M group had significantly less blood loss (M, 340.1 mL; C, 714.3 mL; P=0.005), less postoperative drainage (M, 136.0 mL; C, 627.0 mL; P<0.001), lower rates of red blood cell transfusion (M, 3 cases; C, 10 cases; P=0.029), and a shorter postoperative period of bed rest (M, 2.0 d; C, 3.6 d; P<0.001), compared with the C group. The perioperative complication rates were significantly lower (P=0.012) in the M group (3 patients, 12%) than in the C group (11 patients, 44%). Neurological deficits and pain improved significantly and comparably in the 2 groups after surgery.
  
  
  CONCLUSIONS
  MISt is a less invasive and effective alternative surgery to conventional open surgery for metastatic spinal tumors. MISt should be considered as a valid option for the treatment of metastatic spinal tumor patients with a short life expectancy.
  
  
  METHODS
  Level 3.
authors.affiliation: *Department of Orthopaedic Surgery, Keio University School of Medicine †Keio Spine Research Group (KSRG) ‡Department of Orthopaedic Surgery, Nerima General Hospital §Department of Orthopaedic Surgery, Kawasaki Municipal Hospital ∥Department of Orthopaedic Surgery, Saiseikai Central Hospital ¶Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Hikata
authors.forename: Norihiro
authors.initials: N
authors.lastname: Isogai
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shiono
authors.forename: Haruki
authors.initials: H
authors.lastname: Funao
authors.forename: Eijiro
authors.initials: E
authors.lastname: Okada
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fujita
authors.forename: Akio
authors.initials: A
authors.lastname: Iwanami
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult