Elliot H Choi1, Alvin Y Chan2, Andrew D Gong3, Zachary Hsu2, Andrew K Chan4, Joshua N Limbo2, John D Hong2, Nolan J Brown2, Brian V Lien2, Jordan Davies2, Nihal Satyadev2, Nischal Acharya2, Chen Yi Yang2, Yu-Po Lee5, Kiarash Golshani2, Nitin N Bhatia5, Frank P K Hsu2, Michael Y Oh6. 1. Department of Neurological Surgery, University of California, Irvine, CA, USA; Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. 2. Department of Neurological Surgery, University of California, Irvine, CA, USA. 3. Department of Neurological Surgery, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA. 4. Department of Neurological Surgery, University of California, San Francisco, CA, USA. 5. Department of Orthopedic Surgery, University of California, Irvine, CA, USA. 6. Department of Neurological Surgery, University of California, Irvine, CA, USA. Electronic address: ohm2@uci.edu.
Abstract
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 to total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD): 9.44 minutes; 95% CI: -47.66-66.55 minutes; P = 0.37), surgical blood loss (MD: -84.72 ml; 95% CI: -342.82-173.39 ml; P = 0.34) , length of stay (MD: 1.38 days, 95% CI: -0.95-3.71 days; P = 0.17) and complication rate (OR: 9.47; 95% CI: 0.34-263.56, P = 0.12). Pooled analyses with the random-effects model revealed that 89% of total resection cases improved neurological function whereas 61% of subtotal resection cases improved neurological function. CONCLUSIONS: Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Total resection cases showed slightly better improvements in neurological outcomes compared to subtotal resection cases. 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.
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 to total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD): 9.44 minutes; 95% CI: -47.66-66.55 minutes; P = 0.37), surgical blood loss (MD: -84.72 ml; 95% CI: -342.82-173.39 ml; P = 0.34) , length of stay (MD: 1.38 days, 95% CI: -0.95-3.71 days; P = 0.17) and complication rate (OR: 9.47; 95% CI: 0.34-263.56, P = 0.12). Pooled analyses with the random-effects model revealed that 89% of total resection cases improved neurological function whereas 61% of subtotal resection cases improved neurological function. CONCLUSIONS: Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Total resection cases showed slightly better improvements in neurological outcomes compared to subtotal resection cases. 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.