Table

Considerations in which MISS/OSS may be more feasible for MSD patients.

Considerations When Undertaking MISSOSS More FeasibleMISS More Feasible
Tumor characteristics

  • Hypersclerotic

  • Hypervascular

  • Normal bone quality (based on CT findings)

  • Good hemostasis achieved through preoperative blood management (ie, angioembolization)

Extent of surgery

  • Metastasectomy planned

  • Reconstruction procedures required

  • Significant involvement of posterior column

  • Standard posterior instrumentation and separation surgery

  • No major reconstruction planned

Location of tumor

  • Occipitocervical

  • Cervicothoracic

  • Lumbosacral and sacral

  • Thoracolumbar

Profile of MSD patients

  • Previous surgery at level of operation

  • Pediatric and young patients

  • Short stature

  • Adult patients

  • Normal body habitus

Miscellaneous

  • Lack of availability of specialized equipment/team

  • Lack of postoperative RT

  • Availability of specialized equipment and team

  • Abbreviations: CT, computed tomography; MISS, minimally invasive spinal surgery; MSD, metastatic spinal disease; OSS, open spine surgery; RT, radiotherapy.