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Research ArticleMinimally Invasive Surgery

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

Si Jian Hui, Jiong Hao Tan, Sahil Athia, Priyambada Kumar, Renick Lee, Shahid Ali, Seok Woo Kim and Naresh Kumar
International Journal of Spine Surgery December 2024, 18 (6) 738-744; DOI: https://doi.org/10.14444/8658
Si Jian Hui
1 Department of Orthopedic Surgery, University Spine Center, National University Health System, Singapore, Singapore
MBBS, MRCS (Eᴅɪɴ)
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Jiong Hao Tan
1 Department of Orthopedic Surgery, University Spine Center, National University Health System, Singapore, Singapore
MBBS, MRCS (Eᴅɪɴ), MMed (Oʀᴛʜ), FRCS (Oʀᴛʜ)
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Sahil Athia
2 Royal College of Surgeons in Ireland, Dublin, Ireland
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Priyambada Kumar
1 Department of Orthopedic Surgery, University Spine Center, National University Health System, Singapore, Singapore
MBBS, MS (Orth), FISS
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Renick Lee
1 Department of Orthopedic Surgery, University Spine Center, National University Health System, Singapore, Singapore
BEng
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Shahid Ali
3 King Edward Medical University, Lahore Pakistan, Chowk, Pakistan
MBBS, FCPS (Oʀᴛʜᴏ)
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Seok Woo Kim
4 Spine Center, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
MD
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Naresh Kumar
1 Department of Orthopedic Surgery, University Spine Center, National University Health System, Singapore, Singapore
5 AO Technical Commission Spine Expert Group, Clavadelerstrasse, Switzerland
MBBS (AIIMS); MS Oʀᴛʜ.(AIIMS); DNB Oʀᴛʜ.FRCS Eᴅ.FRCS (Oʀᴛʜ & Trauma); DM (Oʀᴛʜ Spinal Surgery)
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  • For correspondence: dosksn@nus.edu.sg
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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.

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    Table

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

    Considerations When Undertaking MISSOSS More FeasibleMISS 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.

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International Journal of Spine Surgery
Vol. 18, Issue 6
1 Dec 2024
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When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?
Si Jian Hui, Jiong Hao Tan, Sahil Athia, Priyambada Kumar, Renick Lee, Shahid Ali, Seok Woo Kim, Naresh Kumar
International Journal of Spine Surgery Dec 2024, 18 (6) 738-744; DOI: 10.14444/8658

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When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?
Si Jian Hui, Jiong Hao Tan, Sahil Athia, Priyambada Kumar, Renick Lee, Shahid Ali, Seok Woo Kim, Naresh Kumar
International Journal of Spine Surgery Dec 2024, 18 (6) 738-744; DOI: 10.14444/8658
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  • Article
    • Abstract
    • Introduction
    • Methods
    • Results
    • Situations Where Miss May Not Be As Suitable
    • The Role of Miss in MSTS Today
    • Limitations
    • Conclusion
    • Acknowledgments
    • Footnotes
    • References
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  • Comparative Review of Lateral and Oblique Lumbar Interbody Fusion: Technique, Outcomes, and Complications
  • A Spine Surgeon’s Learning Curve With the Minimally Invasive L5 to S1 Lateral ALIF Surgical Approach: Perioperative Outcomes and Technical Considerations
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Keywords

  • metastasis
  • spine
  • tumor
  • open surgery
  • minimally invasive surgery

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