The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries

Abstract

Objective: We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery.

Methods: A worldwide collaborative network group of endoscopic spine surgeons, named 'ESSSORG,' was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months.

Results: A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported.

Conclusion: Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.

Keywords: Endoscopic spine surgery; Minimally invasive spine surgery; Palliative surgery; Quality of life; Spinal metastases.

Fig. 1.

Charts representing the improvement of clinical outcome parameters compared between preoperative and each postoperative periods. (A) The Eastern Cooperative Oncology Group (ECOG). (B) The pain Numeric Rating Scale (NRS). (C) The Oswestry Disability Index (ODI) or the Neck Disability Index (NDI). (D) The EuroQoL 5-Dimension 5-Levels visual analogue scale (EQ5D5L VAS). ^*p < 0.05, statistically significant differences.

Fig. 2.

The Kaplan-Meier estimates graph according to the survival analysis

Fig. 3.

A patient with acute onset of both sides of paraplegia underwent full-endoscopic decompression surgery. (A, B) Preoperative magnetic resonance imaging (MRI) images reveal T10–12 epidural metastases and severe spinal cord compression. (C, D) Intraoperative fluoroscopic images show the optimal position for the interlaminar approach used in this case. (E, F) Postoperative MRI images demonstrate the tumor has been removed and the neural element was free. (G) Postoperative computed tomography scan showed the postlaminectomy site, where wide decompression was achieved.

Fig. 4.

A patient with T4 metastases and acute incomplete spinal cord compression underwent unilateral biportal endoscopic surgery. (A) Annotations in the preoperative computed tomography scan revealed 3 incisions were planned for portals insertion. (B) Intraoperative view during T3–4 decompression demonstrating an optimal visualization, which could facilitate the separation surgery. While the endoscope was approaching from the right side, No. 1 is the lateral border of the dural sac. No. 2 is the posterior longitudinal ligament. No. 3 is the T3–4 intervertebral disc space, and No. 4 is the tumor tissue involving the T4 vertebral body. (C) The photograph demonstrating irrigation flow control using the planned incision portals can help with the bleeding control and provide better visualization. (D, E) Axial preoperative and postoperative magnetic resonance imaging images of the T4 level reveal that wide decompression was achieved.