Endoscopic surgery and laser interstitial thermal therapy in metastatic disease

Description

Hanny Anwar discusses minimally invasive approaches for spinal tumors, focusing on endoscopy and spinal laser interstitial thermal therapy (LITT). He explains that while spinal metastases are common and standard care remains surgery followed by radiotherapy, patients often face long hospital stays and delays to further treatment, motivating interest in faster recovery techniques. He describes endoscopy as a tube-and-camera approach used for biopsy, debulking, and decompression, but cautions that tumor cases are technically harder than degenerative spine surgery and should only be attempted after mastering routine lumbar and cervical endoscopy. He presents cases where endoscopy was used for difficult biopsies, an osteoid osteoma, and chordoma decompression, noting mixed results and emphasising the difficulty of achieving adequate decompression. He then reviews LITT, explaining that it uses MRI-guided laser ablation to create a thermal injury zone and may allow rapid progression to stereotactic radiotherapy, but he questions whether the reported mass reduction is truly attributable to the laser because visible shrinkage may not occur for weeks and radiotherapy is often given before then. He also recounts a personal case using radiofrequency ablation and cement augmentation for spinal metastasis, suggesting possible benefit but acknowledging limited evidence. Overall, he concludes that these technologies are promising but still have unanswered questions, limited evidence, and should not replace surgery when proper decompression is feasible.

DOI: 10.1302/3114- 26 1314

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