HYBRID SURGICAL APPROACHES FOR SPINAL METASTASES: COMBINING OPEN AND MINIMALLY INVASIVE TECHNIQUES

Spinal metastases are a frequent and severe complication of advanced malignancies, often resulting in pain, neurological deficits, and spinal instability, thereby profoundly impairing both function and qual-ity of life. Although traditional open surgical techniques remain effective for decompression and sta-bilization, they are associated with considerable morbidity and prolonged recovery, particularly in pa-tients with limited physiological reserve. Minimally invasive surgical (MIS) techniques have mitigated these limitations by reducing tissue trauma, lowering perioperative blood loss, and shortening hospital stays. Nevertheless, MIS alone may not provide sufficient decompression or stabilization in complex cases. Hybrid surgical approaches that combine open and minimally invasive methods have emerged as a promising strategy to balance oncological control, neurological preservation, and mechanical stabili-ty while minimizing procedural burden. Key techniques include mini-open decompression with percu-taneous fixation, separation surgery combined with stereotactic radiosurgery, and staged interventions designed for high-risk patients. These strategies facilitate earlier initiation of adjuvant therapies and are associated with improved functional outcomes and survival, particularly in patients with radioresistant tumors or intermediate prognostic profiles. The selection of appropriate candidates for hybrid inter-ventions requires meticulous multidisciplinary evaluation supported by prognostic tools such as the NOMS framework, Tokuhashi score, and Tomita score. These systems provide a structured assessment of neurological function, tumor biology, mechanical stability, and systemic condition, thereby enabling individualized treatment planning. Advances in technology, including robotic-assisted fixation, intra-operative navigation, and artificial intelligence, based prognostic modeling, are expected to further enhance the precision, safety, and applicability of hybrid surgical approaches. In conclusion, hybrid surgical strategies represent a significant evolution in the management of spinal metastases, combining the strengths of open and minimally invasive procedures to optimize clinical outcomes and quality of life in patients with metastatic spinal disease.