10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review.

Abstract

INTRODUCTION\nSpinal Metastases are present in approximately 20% of cancer patients, giving a risk for neurological dysfunction and instability. In already frail patients, surgeons strive to improve quality of life. Our goal was to review a 10-year trend in the surgical management of spinal metastases.\n\n\nMETHODS\nA scoping review was performed systematically using PubMed to assess trends in surgical treatment for spinal metastases. The search terms used were: metastas*, neoplasm metastasis [Mesh], Spine [Mesh], spine, spinal, vertebral column , vertebral body, laser, robot, radiofrequency, screws, fixation, separation surgery, corpectomy, vertebrectomy, spondylectomy, vertebroplasty, kyphoplasty, surgery, open surgery, mini open surgery, minimally invasive surgery, endoscopy, thoracoscopy, corpectom*, vertebrectom*, spondylectom*, en bloc and MIS. The variables of interest were neurological improvement, tumor recurrence, reoperation, and overall survival.\n\n\nRESULTS\nA total of 2132 articles were found within the primary query. Fifty-six studies were selected for final review. The results were organized into main surgical practices: decompression, mechanical stabilization, and pain management. For separation surgery, clinical outcomes were: overall-1-year-survival 40.7-78.4%, recurrence-rate 4.3-22%, reoperation 5%, and complications 5.4-14%. For corpectomy, overall-1-year-survival 30-92%, reoperation 1.1-50%, and recurrence-rate of 1.1-28%. Complications and reoperations with spinal instrumentation were 0-13.6% and 0-15% respectively. Cement augmentation achieved pain reduction rates of 56-100%, neurological improvement/stability 84-100%, and complication-rates 6-56%. Laser achieved local tumor control rate of 71-82% at 1-year-follow-up, reoperation-rate of 15-31%, and complication-rate of 5-26%.\n\n\nCONCLUSIONS\nMinimally invasive techniques for decompression and stabilization seem to be the preferred method to surgically treat metastatic spine disease with good outcomes. More research with high level-of-evidence is required to support the long-term outcomes of these approaches.