Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience

Mehta, Ankit I.; Adogwa, Owoicho; Karikari, Isaac O.; Thompson, Paul M.; Verla, Terence; Null, Ulysses; Friedman, Allan H.; Cheng, Joseph; Bagley, Carlos A.; Isaacs, Robert E.

doi:10.3171/2013.9.spine12913

Cited by 52 publications

(30 citation statements)

References 21 publications

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“…In the literature, the CSF leak rate in ID-EM tumor resections ranges from 0%-5% in MIS cases to 0%-9% in open cases. 8,13,14,18,23,33 In our study, the MIS group had a statistically significant decrease in the CSF leak rate of 3.7% compared with the open group leak rate of 16.7% (p = 0.03). A lumbar drain was placed in all of the patients with clinical evidence of postoperative symptomatic CSF leakage (postural headaches or extravasation of CSF beyond the skin).…”

Section: Discussionmentioning

confidence: 43%

Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

Wong

Lall

Dahdaleh

et al. 2015

FOC

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OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.

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Section: Discussionmentioning

confidence: 43%

Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

Wong

Lall

Dahdaleh

et al. 2015

FOC

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“…As the IDEM patients are followed over time with neurological examination and serial magnetic resonance imaging (MRI) to monitor for recurrence, the imaging utilization will likely be higher for reasons of surveillance. 13,38,46,47 Furthermore, steroids are often indicated to ameliorate the peritumoral vasogenic edema, resulting in increased medication cost and overall resource utilization.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

et al. 2017

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BACKGROUND:Healthcare resource utilization and patient-reported outcomes (PROs) for intradural extramedullary (IDEM) spine tumors are not well reported. OBJECTIVE: To analyze the PROs, costs, and resource utilization 1 year following surgical resection of IDEM tumors. METHODS: Patients undergoing elective spine surgery for IDEM tumors and enrolled in a single-center, prospective, longitudinal registry were analyzed. Baseline and postoperative 1-year PROs were recorded. One-year spine-related direct and indirect healthcare resource utilization was assessed. One-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). RESULTS: A total of 38 IDEM tumor patients were included in this analysis. There was significant improvement in quality of life (EuroQol-5D), disability (Oswestry and Neck Disability Indices), pain (Numeric rating scale pain scores for back/neck pain and leg/arm pain), and general physical and mental health (Short-form-12 health survey, physical and mental component scores) in both groups 1 year after surgery (P < .0001). Eighty-seven percent (n = 33) of patients were satisfied with surgery. The 1-year postdischarge resource utilization including healthcare visits, medication, and diagnostic cost was $4111 ± $3596. The mean total direct cost was $23 717 ± $7412 and indirect cost was $5544 ± $4336, resulting in total 1-year cost $29 177 ± $9314. CONCLUSION: Surgical resection of the IDEM provides improvement in patient-reported quality of life, disability, pain, general health, and satisfaction at 1 year following surgery. Furthermore, we report the granular costs of surgical resection and healthcare resource utilization in this population.

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“…3,4,[6][7][8] Studies have also shown improved functional outcome following tumor resection. 1,7 However, there is minimal evidence demonstrating improvement of patient quality of life compared with preoperative values.…”

Section: Discussionmentioning

confidence: 99%

Improved patient quality of life following intradural extramedullary spinal tumor resection

Viereck¹,

Ghobrial²,

Beygi³

2016

SPI

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OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1–3 months postoperatively, 3–12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1–3, 3–12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.

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Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience

Cited by 52 publications

References 21 publications

Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

Improved patient quality of life following intradural extramedullary spinal tumor resection

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