• Elliot H Choi, Alvin Y Chan, Andrew D Gong, Zachary Hsu, Andrew K Chan, Joshua N Limbo, John D Hong, Nolan J Brown, Brian V Lien, Jordan Davies, Nihal Satyadev, Nischal Acharya, Chen Yi Yang, Yu-Po Lee, Kiarash Golshani, Nitin N Bhatia, HsuFrank P KFPKDepartment of Neurological Surgery, University of California, Irvine, California, USA., and Michael Y Oh.
• Department of Neurological Surgery, University of California, Irvine, California, USA; Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
• World Neurosurg. 2021 Jul 1; 151: e343e354e343-e354.

ObjectiveWith 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.MethodsA 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.ResultsSeven studies describing 159 spinal tumor cases were included. Compared with total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD), 9.44 minutes; 95% confidence interval [CI], -47.66 to 66.55 minutes; P = 0.37), surgical blood loss (MD, -84.72 mL; 95% CI, -342.82 to 173.39 mL; P = 0.34), length of stay (MD, 1.38 days; 95% CI, -0.95 to 3.71 days; P = 0.17), and complication rate (odds ratio, 9.47; 95% CI, 0.34-263.56; P = 0.12). Pooled analyses with the random-effects model showed that neurologic function improved in 89% of patients undergoing total resection, whereas neurologic function improved in 61% of patients undergoing subtotal resection.ConclusionsOur analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Patients undergoing total resection showed slightly better improvement in neurologic outcomes compared with patients undergoing subtotal resection. 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.Copyright © 2021. Published by Elsevier Inc.

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