Microscopically-assisted Uninstrumented Surgical Tumor Decompression as an alternative to open surgery for symptomatic metastatic epidural spinal cord compression

Our findings indicate that the MUST-D technique provides surgical advantages compared to standard open surgery for MESCC, with significant improvement in perioperative outcomes. Although both groups had similar 1-year mortality, the MUST-D cohort demonstrated shorter time to RTx, faster postoperative ambulation, improved 30-day ambulatory function, similar index level revision rates, and longer time to death compared to open procedures. With no inferior outcome recorded in our study, the MUST-D technique is observed as an improvement over standard approach. Thus, we propose the MUST-D technique as an alternative treatment modality for symptomatic MESCC decompression. Larger randomized prospective studies with robust clinical correlation are warranted to confirm these findings.