Minimally Invasive Surgery for Treatment of Patients with Advanced Cancer and Thoraco-lumbar Spine Metastases

Spinal metastases are common in patients with cancer. Spinal cord compression is the initial symptom of 5–10% of patients with diffuse cancer, and about 70% of lesions are found in the thoracic vertebrae. Patients with advanced cancer are generally excluded from major spine surgery, to reduce postoperative morbidity and mortality. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, especially in advanced cancer patients, seeking to decrease the morbidity of more traditional open spine surgery; furthermore, reducing the recovery time, MISS permits the post-operative chemotherapy and radiotherapy to begin sooner. A series of 29 cancer patients, with a short life expectancy, presenting acute myelopathy due to vertebral thoracic metastases, underwent MISS, with simple laminotomy and percutaneous stabilization; results from such series were compared to those retrospec‐ tively obtained from an homogenous series of patients operated with traditional open surgery. No significant differences between two groups were demonstrated in terms of surgical complications and neurological recovery. Nevertheless, patients operated with MISS appear to have an earlier recovery and better quality of life in the immediate postoperative period, which is a fundamental aim for patients who have a short life expectancy.