Efficacy and safety profile of spinal laser interstitial thermal therapy for metastatic spinal cord compression.

Abstract

e14657 Background: Metastatic epidural spinal cord compression (MESCC) is a condition where tumor growth encroaches the spinal cord, leading to neurological impairments. Conventional treatments like decompression surgeries are often high-risk, leading to the exploration of minimally invasive options like spinal laser interstitial thermal therapy (sLITT). This meta-analysis evaluates the efficacy and safety of sLITT, a laser-based treatment that effectively relieves spinal cord pressure with low complication rates. Methods: Following PRISMA guidelines, we searched PubMed Central, Google Scholar, and the Cochrane Library for studies including patients with MESCC treated with sLITT, from inception to October 1, 2024. Data on study characteristics, pre- and post-sLITT Bilsky scores, and the incidence of various complications were extracted from studies meeting the predetermined eligibility criteria. Statistical analyses were conducted using a Random Effects Model on Comprehensive Meta-Analysis V4 for Bilsky scores and Open Meta-Analyst (OMA) for complications, with heterogeneity assessed by Cochran’s Q and the I² statistic. Results: An analysis of Bilsky scores from four studies revealed significant improvement in both low- and high-grade scores following spinal laser interstitial thermal therapy (sLITT). For low-grade Bilsky scores (grades 0, 1A, 1B, and 1C), the odds ratio (OR) of 0.126 (95% CI: 0.001 to 24.762, p < 0.001) suggests a postoperative increase in the number of patients with low-grade scores, although heterogeneity was high (I² = 89%). Similarly, high-grade Bilsky scores (grades 2 and 3) showed substantial improvement, with an odds ratio (OR) of 7.833 (95% CI: 2.567 to 23.901, p < 0.001, I² = 75%), indicating a significant clinical benefit, with fewer patients presenting with high-grade scores postoperatively. Complication rates following sLITT were low: atrial fibrillation occurred in 0.8% of patients (95% CI: 0.1%–2.3%, p = 0.005, I² = 0%), extremity weakness in 1.5% (95% CI: 0.3%–3.6%, p < 0.001, I² = 19.3%), fractures in 3.9% (95% CI: 1.2%–8.0%, p < 0.001, I² = 51.3%), and infections in 1.5% (95% CI: 0.2%–4.3%, p = 0.004, I² = 12.5%). Nerve root palsy, spinothalamic dysfunction, wound dehiscence, and pulmonary embolism were also infrequent, with pooled incidence rates between 1.1% and 2.5% and no notable heterogeneity observed in most cases. Sensitivity analysis confirmed that the results were robust, with variability likely due to inherent differences across the studies. Conclusions: Spinal Laser Interstitial Thermal Therapy shows promise as a minimally invasive treatment for MESCC, offering significant spinal cord decompression with minimal complications. Positive Bilsky score outcomes highlight its effectiveness, mainly for patients ineligible for traditional surgery. Further research is needed to refine its clinical use and optimize patient selection.