Comparison of Wiltse Approach‐Based Invasion‐Controlled Surgery With Traditional Open Surgery for Thoracolumbar Spinal Metastases Within the NOMS Framework

ABSTRACT Objectives To compare Wiltse approach‐based invasion‐controlled surgery ( ICS ) with traditional open surgery ( TOS ) for symptomatic thoracolumbar spinal metastases within the Neurologic, Oncologic, Mechanical, and Systemic ( NOMS ) framework, focusing on perioperative burden, postoperative recovery, neurological outcomes, pain, and QLQ ‐ BM22 domains. Methods This retrospective cohort study included 30 patients undergoing ICS and 60 patients undergoing TOS from January 25, 2019, to January 25, 2022. Perioperative, neurological, and patient‐reported outcomes were compared, including operative burden, postoperative recovery, complications, ASIA grade, VAS score, and QLQ ‐ BM22 domains. Continuous variables were assessed with Shapiro–Wilk tests and compared using two‐sided Welch independent‐samples t ‐tests; categorical variables were analyzed using Pearson's χ 2 or exact tests, and Mann–Whitney U tests were used for sensitivity analyses when patient‐level data were available. Results The groups differed in preoperative ASIA distribution ( p = 0.036). Compared with TOS , ICS was associated with shorter operative time ( p < 0.001), lower blood loss ( p = 0.005), lower transfusion volume ( p < 0.001), less postoperative drainage ( p = 0.021), earlier ambulation ( p < 0.001), and a shorter interval to subsequent oncologic treatment ( p < 0.001). The day‐1 leukocyte count was lower in the ICS group ( p = 0.028), whereas C‐reactive protein was higher ( p = 0.042). The overall complication frequency ( p = 1.000), postoperative‐week‐2 ASIA distribution ( p = 0.247), and favorable neurological outcome frequency (53.3% vs. 50.0%, p = 0.766) did not differ significantly between groups. Conclusions Wiltse approach‐based ICS was associated with reduced operative burden and faster postoperative recovery, without evidence of a worse postoperative neurological distribution in the unadjusted comparison. ICS may be considered a complementary muscle‐sparing option within NOMS ‐guided management for appropriately selected patients who require posterior stabilization with decompression or separation. Trial Registration: ClinicalTrials.gov identifier: ChiCTR1800016921.