Clinical Outcomes of Image-Guided Spinal Laser Interstitial Thermal Therapy for Metastatic Epidural Spinal Disease: A Systematic Review and Narrative Synthesis.

Metastatic epidural spinal cord compression (MESCC) causes pain, neurological deficits, and reduced quality of life. While open surgery and radiotherapy are standard treatments, frail patients are often poor surgical candidates. Image-guided spinal laser interstitial thermal therapy (sLITT) has emerged as a minimally invasive alternative to reduce epidural tumor burden and facilitate radiotherapy. We systematically searched PubMed, Embase, Scopus, and Web of Science (inception to 31 January 2026) for clinical reports on image-guided sLITT for malignant epidural spinal disease treated with decompressive intent. Two reviewers extracted data, with a third resolving discrepancies. Meta-analysis was precluded by clinical heterogeneity and potential cohort overlap, yielding seven included studies. The included studies evaluated standalone magnetic resonance-guided sLITT, hybrid sLITT with percutaneous stabilization, and sLITT combined with stereotactic radiotherapy. Reported outcomes suggested short-term improvements in epidural tumor thickness and epidural spinal cord compression (ESCC) grade, neurological stability, brief hospitalizations, and lower perioperative resource use compared to open surgery in one matched observational study. However, safety reporting was heterogeneous, and the certainty of evidence was very low due to small sample sizes, retrospective designs, short follow-up, and inconsistent outcome measurements. Image-guided sLITT appears feasible for carefully selected patients with metastatic epidural disease, but evidence regarding durable neurological benefit, survival, and long-term local control remains uncertain. Larger, prospective multicenter studies utilizing standardized neurological, radiographic, safety, and patient-reported outcomes are required.