When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?

Background: Metastatic spine tumor surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment till the early 2010s. However, advancements in MSTS in recent years have led to the advent of minimally invasive spinal surgery (MISS) techniques for the treatment of MSD. The clear benefits of MISS have resulted in a current paradigm shift toward today's gold standard of MISS and early adjuvant radiotherapy in treating MSD patients. Nonetheless, despite improvements in surgical techniques and the rise of literature supporting MISS for MSD, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations of not using MISS in MSD in today's clinical context. Methods: A narrative review was conducted for this manuscript. All studies related to OSS and MISS in MSTS were included. Results: A total of 54 studies were included in this review. These studies discussed various advantages of MISS for MSD in today's clinical context, including the patient profile, location of vertebrae involved with metastasis requiring treatment, tumor characteristics, as well as equipment availability. Conclusion: This study establishes situations in which MISS can be less applicable despite the advantages it may confer over traditional OSS. MSTS should be individualized, depending on the experience of the surgeon. OSS is a time- tested approach that still holds weight in MSTS and should be readily utilized depending on the clinical situation. Level of Evidence: 4.