Comparison of minimally invasive total versus subtotal resection of spinal tumors: a systematic review and meta-analysis.

Abstract Objective With the advent of minimally invasive techniques, minimally invasive spine surgery (MISS) has become a realistic option for many spine cases. This study aims to evaluate the operative and clinical outcomes of MISS for total versus subtotal tumor resection from current evidence. Methods A literature search was performed using the search term, (Minimally invasive surgery OR MIS) AND (spine tumor OR spinal tumor). Studies including both minimally invasive total and subtotal resection cases with operative or clinical data were included. Results Seven studies describing 159 spinal tumor cases were included. Compared to total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD): 9.44 minutes; 95% CI: -47.66-66.55 minutes; P = 0.37), surgical blood loss (MD: -84.72 ml; 95% CI: -342.82-173.39 ml; P = 0.34) , length of stay (MD: 1.38 days, 95% CI: -0.95-3.71 days; P = 0.17) and complication rate (OR: 9.47; 95% CI: 0.34-263.56, P = 0.12). Pooled analyses with the random-effects model revealed that 89% of total resection cases improved neurological function whereas 61% of subtotal resection cases improved neurological function. Conclusions Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Total resection cases showed slightly better improvements in neurological outcomes compared to subtotal resection cases. Overall, this study suggests that both total and subtotal resection may result in comparable outcomes for patients with spinal tumors. However, maximal safe resection remains the ideal treatment because it provides the greatest chance of long-term benefit.