Comparison of Minimally Invasive Total versus Subtotal Resection of Spinal Tumors: A Systematic Review and Meta-Analysis

OBJECTIVE: With the advent of minimally invasive techniques, minimally invasive spine surgery (MISS) has become a realistic option for many spine cases. This study aims to evaluate the operative and clinical outcomes of MISS for total versus subtotal tumor resection from current evidence. METHODS: A literature search was performed using the search term (Minimally invasive surgery OR MIS) AND (spine tumor OR spinal tumor). Studies including both minimally invasive total and subtotal resection cases with operative or clinical data were included. RESULTS: Seven studies describing 159 spinal tumor cases were included. Compared with total resection, sub -total resection showed no significant differences in sur-gical time (mean difference (MD), 9.44 minutes; 95% confidence interval [CI],-47.66 to 66.55 minutes; P = 0.37), surgical blood loss (MD,-84.72 mL; 95% CI,-342.82 to 173.39 mL; P = 0.34), length of stay (MD, 1.38 days; 95% CI,-0.95 to 3.71 days; P = 0.17), and complication rate (odds ratio, 9.47; 95% CI, 0.34-263.56; P = 0.12). Pooled analyses with the random-effects model showed that neurologic function improved in 89% of patients undergoing total resection, whereas neurologic function improved in 61% of patients undergoing subtotal resection. CONCLUSIONS: Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Patients undergoing total resection & nbsp;showed slightly better improvement in neurologic out-comes compared with patients undergoing subtotal resection. Overall, this study suggests that both total and subtotal resection may result in comparable outcomes for patients with spinal tumors. However, maximal safe resection remains the ideal treatment because it provides the greatest chance of long-term benefit.

Automated summary

This study found no significant difference in operative outcomes between total and subtotal resection for spinal tumors, but patients undergoing total resection showed slightly better improvement in neurological function compared to those undergoing subtotal resection. Overall, both total and subtotal resection may result in comparable outcomes for patients with spinal tumors, with maximal safe resection being the ideal treatment to provide the greatest chance of long-term benefit.