When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?

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Figure 1
Flow diagram of the review and selection of cases.
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Figure 2
Example of patient with oligometastasis undergoing metastectomy and requiring open spine surgery.
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Figure 3
Exampled of open spine surgery having good access to posterior elements allowing thorough decompression and metastectomy.

Table

Considerations in which MISS/OSS may be more feasible for MSD patients.

Considerations When Undertaking MISS	OSS More Feasible	MISS More Feasible
Tumor characteristics	Hypersclerotic Hypervascular	Normal bone quality (based on CT findings) Good hemostasis achieved through preoperative blood management (ie, angioembolization)
Extent of surgery	Metastasectomy planned Reconstruction procedures required Significant involvement of posterior column	Standard posterior instrumentation and separation surgery No major reconstruction planned
Location of tumor	Occipitocervical Cervicothoracic Lumbosacral and sacral	Thoracolumbar
Profile of MSD patients	Previous surgery at level of operation Pediatric and young patients Short stature	Adult patients Normal body habitus
Miscellaneous	Lack of availability of specialized equipment/team Lack of postoperative RT	Availability of specialized equipment and team

Abbreviations: CT, computed tomography; MISS, minimally invasive spinal surgery; MSD, metastatic spinal disease; OSS, open spine surgery; RT, radiotherapy.