Minimal Access Surgery for Spinal Metastases: Prospective Evaluation of a Treatment Algorithm Using Patient-Reported Outcomes

BACKGROUND: Minimal access surgery (MAS) allows early return to systemic and radiation therapy in patients with cancer leading to its increasing utilization in the treatment of spinal metastases. Systematic examination of surgical indications resulted in the development of an algorithm for implementation of MAS in the treatment of spinal metastases. The object of this study was to evaluate a spine tumor MAS treatment algorithm using patient-reported outcomes in cancer patients undergoing treatment of spinal metastases. METHODS: A prospective cohort study. Patients who underwent spinal percutaneous instrumented stabilization with the addition of MAS cord or nerve root decompression and/or kyphoplasty when indicated at a tertiary cancer center between December 2013 and August 2016 were included. Validated patient reported outcome (PRO) measures including the Brief Pain Inventory (BPI) and the MD Anderson Symptom Inventory – Spine module (MDASI-sp) were utilized. PROs were collected and compared at baseline, 3 month and long-term follow up (4.5–12 months). RESULTS: Fifty-one patients were included. MAS resulted in a statistically significant decrease in the severity of pain, and improved activity, ability to work and enjoyment of life (P