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DOS Kongressen 2017 ·
185
Minimal Access vs. Open Spine Surgery in Patients
with Metastatic Spinal Cord Compression. Prelimi-
nary Results from a One-Center Randomized Con-
trolled Trial
Søren Schmidt Morgen, Lars Valentin Hansen, Robert Svardal-Stelmer, Martin
Gehrchen, Benny Dahl
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of
Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet,
University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rig-
shospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic
Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of
Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background:
Minimally access spine surgery (MASS) is considered less morbid
than open surgery (OS), but evidence from studies comparing MASS with OS in
patients with metastatic spinal cord compression (MSCC) is limited. We exam-
ined the feasibility and efficacy of MASS versus OS in a randomized controlled
study with 50 MSCC patients.
Purpose / Aim of Study:
The objective of this study was to assess whether
patients operated with MASS would experience a shorter operation time and
less perioperative bleeding than patients treated with OS.
Materials and Methods:
During 2012 to 2017 a total of 50 MSCC patients
were included in a one-center, randomized controlled trial with 1-year follow
up. Patients were randomized to either MASS or OS. Only patients with MSCC
between T5 to L3 where included. Patients with Tokuhashi score ≤ 4, in need
of sacral or iliosacral instrumentation. All patients were operated with posterior
pedicle screw instrumentation two levels above and two levels below the meta-
static level. In the MASS-group decompression was done through a localized
incision at the metastatic level. A p-value < 0.05 was considered statistically
significant.
Findings / Results:
The mean age was 67 years (range 43- 89) and 40% were
men. The mean operation time was longer for patients operated with MASS
when compared to OS; 140 min vs. 118 min. However, this difference was not
statistical significant (p = 0.09). The peri- operative blood loss in the MASS-
group was significantly smaller than in the OS- group; 234 ml vs. 650 ml (p =
0.0037). There was no significant difference in the amount of revisions in the
MASS versus the OS group; with two revisions in each group.
Conclusions:
Surgical treatment of symptomatic MSCC with MASS technique
results in significantly and clinically relevant less of blood loss to open surgery.
No conflicts of interest reported
137.