Minimally invasive versus open surgery for patients undergoing intradural extramedullary spinal cord tumor resection: A systematic review and meta-analysis

Introduction: Given the potential injury to the spinal cord and the nerve roots during the surgery and the necessity of minimal spinal cord manipulation during surgery, minimally invasive surgical techniques have emerged as alternatives to conventional open surgery in resection of ID-EM tumors.Methods: An electronic database search was conducted, and the review was carried out according to PRISMA guidelines and recommendations. Inclusion criteria were as follows; (i) comparative studies of MIS vs OS; (ii) studies reporting outcomes for patients undergoing surgery for ID-EM tumors. Variables collected were patient demographics, estimated blood loss (EBL), mean operative time, length of stay, complications, extent of tumor resection. Results: The search identified a total of 275 studies. After the selection criterion was applied 7 comparative studies were included. A total of 302 patients were included in the analysis with 149 (49.3%) of them undergoing MIS and 153 of them (50.7%) undergoing open surgery. EBL, operative time, and LOS were significantly lower in MIS group (p < 0.0001, p < 0.0001, and p = 0.0002 respectively). Two groups were similar with regards to the rates of surgical complications, medical complications and gross total resection. The most common surgical complication was CSF leak (52.3% of all complications).Conclusion: Results of this meta-analysis show a significant reduction in EBL, operative time, and length of stay with MIS while proving safe and preserving high rates of gross-total resection. The findings suggest that the minimally invasive spine surgery may serve as a beneficial alternative for patients undergoing spine surgery for ID-EM tumors of the spinal cord.