The Potential of Minimally Invasive Surgery to Treat Metastatic Spinal Disease versus Open Surgery: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVE: Metastasis to the spinal column is a common feature of primary tumors of the breast, prostate, lung, and other organs. Surgical intervention can be performed via the traditional open surgery (OS) approach or the minimally invasive surgery (MIS) approach. This study aims to assess the available evidence of perioperative outcomes of MIS versus OS for patients with metastatic spinal disease. METHODS: We followed recommended PRISMA guidelines for systematic reviews. Six electronic databases were searched to identify all potentially relevant studies published from inception to October 2017. Data were extracted and analyzed using meta-analysis of proportions. RESULTS: Six studies satisfied the criteria for inclusion into this study. There were 292 patients with metastatic spinal disease described in the cohort, treated with either MIS (n = 155, 53%) or OS (n = 137, 47%). Compared with OS, MIS resulted in statistically significant reduction in blood loss (mean difference, -601.48 mL; P < 0.001) and length of stay (mean difference, -4.60 days; P = 0.002). In terms of complications, MIS had a significantly reduced incidence compared with OS (21/155 [14%] and 37/136 [27%], respectively; odds ratio, 0.41; P = 0.005). In terms of operation duration (P = 0.43), postoperative functional (P = 0.76) and pain (P = 0.84) outcomes, MIS was non-inferior to OS. CONCLUSIONS: Surgical intervention by an MIS approach in patients with metastatic spinal disease seems to provide equivalent outcomes compared with OS and reduces morbidity and length of stay. Future studies that are larger, prospective, and longer-term will validate the findings of this study and elucidate the optimal role for MIS in the surgical management of metastatic spinal disease.