Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review

Study design: The study design of this paper is a systematic review of literature published in the recent 10 years. Objective: It is the objective of this paper to compare the clinical efficacy and safety of minimal access (MIS) spinal surgery and open spinal surgery for treating painful spine metastasis. Methods: Two research questions below were determined through a consensus among a panel of spine experts. A systematic review of literature on spinal surgery was conducted by searching PubMed with a combination of keywords including metastatic, metastasis, metastases, spinal, and spine. Independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows: 1. In patients with spine metastatic disease, what is the impact of different surgical approaches (MIS versus open) on pain relief and functional outcome? 2. In patients with metastatic disease, what is the impact of different surgical approaches (MIS versus open) on local recurrence, survive rate, and complication? Results: A total of 1,076 abstracts were identified using various keywords. 5 prospective (level II) and 12 retrospective articles (level III) were eligible for inclusion, involving a total of 979 cases of spine metastasis. There were 345 cases in 8 studies regarding the clinical evaluation of MIS spinal surgery and 634 cases in 9 studies regarding the clinical evaluation of open spinal surgery for spine metastasis. Conclusion: Both open spinal surgery and MIS seem to achieve the improvement of pain and neurological dysfunction through decompression and stabilization for patients with spine metastasis, but open surgery may involve more major complications with a trend of lower survival rates and higher recurrence rates compared to MIS.