Minimally-invasive Tubular Surgery Versus Conventional Surgery in the Treatment of Spinal Metastasis: a Retrospective Case-control Study

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Background: This study aims to evaluate the perioperative safety and efficacy of minimally-invasive tubular surgery for spinal metastasis with different blood supply. Methods: 72 patients with spinal metastasis between January 2011 to June 2020 were retrospectively reviewed. 14 patients underwent minimally-invasive tubular surgery (Mini-invasive group), and 58 patients underwent conventional surgery (Conventional group). T-test and Mann–Whitney U test was used to evaluate the difference in demographic and perioperative data between the two groups. Results: Baseline characteristics did not differ significantly between the two groups except for the Tokuhashi score (p=0.036). Overall, conventional group had significantly more blood loss (P=0.001), blood transfused(P=0.027), drainage(P<0.001), and longer time of drainage tube(P<0.001), postoperative hospitalization(P=0.002) compared with the mini-invasive group. Sub-analysis showed that for patients with hypo-vascular tumor, trans-channel decompression surgery had all advantages mentioned above. For patients with hyper-vascular tumor, trans-channel decompression surgery only had advantages on the drainage related events. Patients with hyper-vascular tumor had significantly more blood loss compared with patients with hypo-vascular tumor among mini-invasive group. Conclusion: In selected cases with spinal metastasis, minimally-invasive tubular surgery is safe and effective for patients with spinal metastasis. Patients with hypo-vascular tumor were more suitable for this technique with less blood loss, less blood transfused, less drainage and shorter postoperative hospitalization.