Minimally Invasive Spine Surgery for Metastatic Spine Disease

  • Joseph H. SchwabEmail author


The prevalence of cancer continues to increase as the population ages. More and more people are living with metastatic cancer for which there is no cure but many treatments. The goals of treatments generally focus on extending the life of the patient in the context of maintaining or improving their quality of life. Surgery for the management of spinal metastasis may indirectly increase survival in patients with impending or active neurologic compromise by preventing paralysis. The benefits of preventing paralysis in terms of quality of life are readily apparent as well. However, surgery can be associated with significant morbidity which must be balanced against the potential improvement in quality of life. Furthermore, patients with spinal metastases, by definition, are not curable, and most patients will not survive greater than 1 year. In fact patients with aggressive tumors may only survive a few months and it is undesirable for patients to spend their remaining time recovering from a morbid procedure. Advances in minimally invasive operative techniques combined with improvements in adjuvant therapies such as stereotactic radiosurgery provide an opportunity to render effective treatment for spinal metastases with less morbidity.


Minimally spine metastasis Percutaneous pedicle screws Epidural spinal cord compression Stereotactic radiosurgery Pathologic fracture Kyphoplasty Vertebroplasty Metastatic spine Bone metastasis 


  1. 1.
    American Cancer Society 2013 [Internet]; 2013 [cited November 4].
  2. 2.
    Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, et al. Prediction of quality of life and survival after surgery for symptomatic spinal metastases: a multicenter cohort study to determine suitability for surgical treatment. Neurosurgery. 2015;77(5):698–708.CrossRefPubMedGoogle Scholar
  3. 3.
    Paulino Pereira NR, Janssen SJ, van Dijk E, Harris MB, Hornicek FJ, Ferrone ML, et al. Development of a prognostic survival algorithm for patients with metastatic spine disease. J Bone Joint Surg Am. 2016;98(21):1767–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Goodwin CR, Khattab MH, Sankey EW, Elder BD, Kosztowski TA, Sarabia-Estrada R, et al. Factors associated with life expectancy in patients with metastatic spine disease from adenocarcinoma of the lung. Global Spine J. 2015;5(5):417–24.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nathan SS, Healey JH, Mellano D, Hoang B, Lewis I, Morris CD, et al. Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care. J Clin Oncol. 2005;23(25):6072–82.CrossRefPubMedGoogle Scholar
  6. 6.
    Paulino Pereira NR, Mclaughlin L, Janssen SJ, van Dijk CN, Bramer JAM, Laufer I, et al. The SORG nomogram accurately predicts 3- and 12-months survival for operable spine metastatic disease: external validation. J Surg Oncol. 2017;115(8):1019–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, et al. Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort. Br J Neurosurg. 2016;30(3):337–44.CrossRefPubMedGoogle Scholar
  8. 8.
    Abu-Bonsrah N, Goodwin CR, De la Garza-Ramos R, Sankey EW, Liu A, Kosztowski T, et al. Readmissions after surgical resection of metastatic tumors of the spine at a single institution. World Neurosurg. 2017;101:701.e1.CrossRefGoogle Scholar
  9. 9.
    Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, Chiu CK, Viezens L, Chan TS, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976). 2017;42(10):789–97.CrossRefGoogle Scholar
  10. 10.
    Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, et al. Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18(3):207–14.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin JY, Rosenblum M, Movsas B, Kim JH. Radiosurgical decompression of metastatic epidural compression. Cancer. 2010;116(9):2250–7.PubMedGoogle Scholar
  12. 12.
    Marcove RC, Miller TR. Treatment of primary and metastatic bone tumors by cryosurgery. JAMA. 1969;207(10):1890–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Rose PS, Morris JM. Cryosurgery/cryoablation in musculoskeletal neoplasms: history and state of the art. Curr Rev Musculoskelet Med. 2015;8(4):353–60.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    McMenomy BP, Kurup AN, Johnson GB, Carter RE, McWilliams RR, Markovic SN, et al. Percutaneous cryoablation of musculoskeletal oligometastatic disease for complete remission. J Vasc Interv Radiol. 2013;24(2):207–13.CrossRefPubMedGoogle Scholar
  15. 15.
    Ha KY, Kim YH, Yoo TW. Intraoperative radiofrequency ablation for metastatic spine disease: report of 4 cases and review. Eur J Orthop Surg Traumatol. 2013;23(Suppl 2):S129–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Adachi A, Kaminou T, Ogawa T, Kawai T, Takaki Y, Sugiura K, et al. Heat distribution in the spinal canal during radiofrequency ablation for vertebral lesions: study in swine. Radiology. 2008;247(2):374–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Simon CJ, Dupuy DE. Image-guided ablative techniques in pelvic malignancies: radiofrequency ablation, cryoablation, microwave ablation. Surg Oncol Clin N Am. 2005;14(2):419–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Tatsui CE, Nascimento CNG, Suki D, Amini B, Li J, Ghia AJ, et al. Image guidance based on MRI for spinal interstitial laser thermotherapy: technical aspects and accuracy. J Neurosurg Spine. 2017;26(5):605–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1–202.PubMedCentralGoogle Scholar
  20. 20.
    Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225–35.CrossRefPubMedGoogle Scholar
  21. 21.
    Schwab JH, Gasbarrini A, Cappuccio M, Boriani L, De Iure F, Colangeli S, et al. Minimally invasive posterior stabilization improved ambulation and pain scores in patients with plasmacytomas and/or metastases of the spine. Int J Surg Oncol. 2011;2011:239230.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Hong CG, Cho JH, Suh DC, Hwang CJ, Lee DH, Lee CS. Preoperative embolization in patients with metastatic spinal cord compression: mandatory or optional? World J Surg Oncol. 2017;15(1):3.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Harvard Medical School, Massachusetts General HospitalBostonUSA

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