====== Spinal laser interstitial thermotherapy ======

The proximity of the [[spinal cord]] to compressive [[spinal metastases]] limits radiosurgical dosing. Open [[surgery]] is used to create safe margins around the spinal cord prior to [[spinal stereotactic radiosurgery]] (SSRS) but carries the risk of potential surgical [[morbidity]] and interruption of systemic oncological treatment. Spinal [[laser interstitial thermotherapy]] (SLITT) in conjunction with SSRS provides local control with less [[morbidity]] and a shorter interval to resume systemic treatment. 
de Almeida Bastos et al. presented a comparison between SLITT and open surgery in patients with metastatic thoracic epidural spinal cord compression to determine the advantages and disadvantages of each method.

This is a matched-group design study comprising patients from a single institution with metastatic thoracic epidural spinal cord compression that was treated either with SLITT or open surgery. The two cohorts defined by the surgical treatment comprised patients with epidural spinal cord compression (ESCC) scores of 1c or higher and were deemed suitable for either treatment. Demographics, pre- and postoperative ESCC scores, histology, morbidity, hospital length of stay (LOS), complications, time to radiotherapy, time to resume systemic therapy, progression-free survival (PFS), and overall survival (OS) were compared between groups.

Eighty patients were included in this analysis, 40 in each group. Patients were treated between January 2010 and December 2016. There was no significant difference in demographics or clinical characteristics between the cohorts. The SLITT cohort had a smaller postoperative decrease in the extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p < 0.001), shorter LOS (3.4 vs 9 days, p < 0.001), lower overall complication rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p < 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were similar between groups (p = 0.510 and p = 0.868, respectively).

This results have shown that SLITT plus XRT is not inferior to open decompression surgery plus XRT in regard to local control, with a lower rate of complications and faster resumption of oncological treatment. A prospective randomized controlled study is needed to compare SLITT with open decompressive surgery for ESCC
((de Almeida Bastos DC, Everson RG, de Oliveira Santos BF, Habib A, Vega RA, Oro
M, Rao G, Li J, Ghia AJ, Bishop AJ, Yeboa DN, Amini B, Rhines LD, Tatsui CE. A
comparison of spinal laser interstitial thermotherapy with open surgery for
metastatic thoracic epidural spinal cord compression. J Neurosurg Spine. 2020 Jan
3:1-9. doi: 10.3171/2019.10.SPINE19998. [Epub ahead of print] PubMed PMID:
31899882.
)).
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In 2017 Thomas et al. stated that spinal laser interstitial thermal therapy (LITT) appears to be a promising novel modality for the treatment of epidural metastatic spine disease in patients who are poor candidates for larger-scale oncologic spinal surgery and can act synergetically with spinal stereotactic radiosurgery to maximize local control and palliate pain. This technique is ideally suited for the intraoperative MRI suite to monitor the extent of the ablation in the epidural space. As percutaneous navigation, imaging, and LITT technology improve, broader applicability of this minimally invasive technique in spinal oncology is foreseen
((Thomas JG, Al-Holou WN, de Almeida Bastos DC, Ghia AJ, Li J, Bishop AJ, Amini 
B, Rhines LD, Tatsui CE. A Novel Use of the Intraoperative MRI for Metastatic
Spine Tumors: Laser Interstitial Thermal Therapy for Percutaneous Treatment of
Epidural Metastatic Spine Disease. Neurosurg Clin N Am. 2017 Oct;28(4):513-524.
doi: 10.1016/j.nec.2017.05.006. Epub 2017 Aug 19. Review. PubMed PMID: 28917280.
)).
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A study demonstrated the feasibility of image guidance based on MRI to perform laser interstitial thermotherapy of spinal metastasis. The authors' method permits excellent visualization of the spinal cord, improving safety and workflow during laser ablations in the epidural space. The results can be extrapolated to other indications, including biopsies or drainage of fluid collections near the spinal cord
((Tatsui CE, Nascimento CNG, Suki D, Amini B, Li J, Ghia AJ, Thomas JG, Stafford
RJ, Rhines LD, Cata JP, Kumar AJ, Rao G. Image guidance based on MRI for spinal
interstitial laser thermotherapy: technical aspects and accuracy. J Neurosurg
Spine. 2017 May;26(5):605-612. doi: 10.3171/2016.9.SPINE16475. Epub 2017 Feb 10. 
PubMed PMID: 28186470.)).

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