Perioperative outcomes after minimally invasive and open surgery for treatment of spine metastases: a systematic review and meta-analysis
Bibliographic record
Abstract
OBJECTIVE: This systematic review and meta-analysis compared minimally invasive surgery (MIS) to open surgery for treatment of spinal metastases with respect to perioperative outcomes. Few studies have systemically assessed the body of evidence on this topic. METHODS: A systematic review of EMBASE and PubMed from database inception to December 2023 was performed to identify studies comparing MIS with open surgery for the treatment of spine metastases. Nine outcomes were collected: estimated blood loss (EBL), operative time, hospital length of stay (LOS), risk of revision, risk of neurological deterioration, likelihood of receiving postoperative radiation therapy, time to radiation therapy, time to chemotherapy, and treatment of pain measured through patient-reported visual analog scale (VAS) scores. Meta regression was used to estimate adjusted mean differences (aMDs) and adjusted odds ratios (aORs) for outcomes. Certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS: There were 34 eligible studies including 1656 patients with spinal metastases; 904 (54.6%) patients were treated with MIS and 752 (45.4%) were treated with open surgery. MIS was associated with significantly less blood loss (aMD -602 mL, 95% CI -1204 to -0.2 mL; I2 = 97%) with a moderate certainty of evidence. MIS was found to be noninferior with respect to operative time (aMD -2.6 minutes, 95% CI -53.3 to 48.1 minutes; I2 = 88%), risk of revision (aOR 0.9, 95% CI 0.8-1.1; I2 < 0.01), risk of neurological deterioration (aOR 0.9, 95% CI 0.8-1.0; I2 < 0.01), likelihood of postoperative radiation therapy (aOR 0.9, 95% CI 0.7-1.4; I2 < 0.01), and postoperative VAS score (aMD -0.6, 95% CI -1.5 to 0.4; I2 = 52%) with low certainty of evidence. MIS was associated with significantly shorter time to chemotherapy (MD -0.9 weeks, 95% CI -1.9 to -0.01 weeks; I2 = 22%), with very low certainty of evidence. Inferences for LOS and time to radiation were indeterminate; however, we found a trend toward earlier radiation therapy with MIS that was significant in the subgroup of patients treated with decompression and fusion. CONCLUSIONS: Treatment with MIS compared with open surgery was associated with reduced EBL, shorter time to chemotherapy, similar operative time, and similar reductions in postoperative pain. Limitations were largely due to heterogeneity across studies. Future research among subgroups is very likely to improve certainty in the comparative effect estimates.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.038 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.042 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".