Introduction: We investigated whether minimally invasive vs. open approaches to tumor resection can reduce morbidity, correct deformity, and provide lasting benefit.
Methods: Patients with a diagnosis of cancer and MRI evidence of metastatic epidural spinal cord compression underwent minimally invasive surgery (MIS). Outcomes were compared against controls undergoing open surgery.
Results: 30 patients underwent 32 MIS procedures vs. 51 controls undergoing open surgery. Average surgical time (hours) was 2.8 in the MIS group vs. 4.43 in the open group, average EBL (ml) was 592.83 vs. 988.03, average hospital stay (days) was 6.69 vs. 10.05, and average time to ambulation (days) were 1.38 vs. 5.51. Among patients with poor ambulation one-month post-op, MIS patients improved significantly by an average of 2.25 Hauser score levels vs. control showing no improvement. Among MIS patients, Cobb angle decreased significantly vs. control showing no improvement. Among open patients there were 7 DVT, 5 PE, and 6 wound infections in the first 30 days vs. none in the MIS group. In the MIS population the average period between recurrences was 6 months; those with surgical recurrence within 4 months of the initial procedure did not undergo any further procedures; they survived for an average of 4.7 months. Those with a recurrence more than 4 months after the index procedure survived more than 28 months on average, underwent an average of 3.75 procedures each, with an average period between re-operations of 6.9 months. Survival correlated to their JSI scores, which was significantly higher in the MUST-D group than the open group, although all of the other tumor scoring or co-morbidity scores were not significantly different pre-operatively to suggest any other differences between the two groups.
Conclusions: MIS had shorter procedures, hospital stays, reduced EBL, better improvement in spinal deformity, increased improvement in ambulation status when compared to open surgery. Low rates of infection and other post-operative complications improve the quality of life for patients in general. Survival differences between the two groups were predicted by their Jenkins Survival Index scores rather than their local disease severity or any other accepted tumor index scores.
Patient Care: offering less invasive ways to treat spinal metastatic disease
Learning Objectives: What treatment options exist for patients with spinal cord compression from metastatic disease?
What is the difference in outcomes between these two treatment options?
Are there any factors that predict outcomes between the two options?