Clinical Efficacy of Laminectomy with Instrumented Fixation in Treating Thoracolumbar Intradural Extramedullary Schwannomas: A Comparative Study

Abstract

Departmental sources Background:This study investigated the clinical effect of laminectomy plus pedicle screw fixation in treating thoracolumbar intradural extramedullary schwannomas. Material/Methods:Between October 2011 and May 2017, 57 patients undergoing resection of thoracolumbar schwannomas were retrospectively identified and included in the study. Based on the surgical procedures used, all participants were assigned to either the laminectomy-only group (n=33) or the combination group (laminectomy plus pedicle screw fixation, n=24). All participants were followed up for over 2 years. In the laminectomy, the spinal process, vertebral laminae, and bilateral upper articular processes of the surgical segments were completely resected and the lower articular processes were reserved. For further analysis, we evaluated the pain levels using visual analogue scale (VAS) score. The assessment of neurological function was performed with Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). The comparisons of Cobb angle changes were carried out pre-surgery and post-surgery. Results:The demographic data were well matched between the laminectomy-only group and combination group, without significant differences (P>0.05). After surgery, both surgical procedures achieved significant improvement in VAS score, ODI, and JOA score (P<0.001), but no significant differences were found between these 2 surgical procedures (P>0.05). The postoperative change in Cobb angle indicated a significant difference in the laminectomy-only group, but not in the combination group (P<0.05). In addition, postoperative spinal instability/ deformity was found in the laminectomy-only group (P<0.05). Conclusions:In conclusion, the combination of laminectomy and pedicle screw fixation is a safe and effective surgical procedure when used to treat thoracolumbar schwannoma, and appears to be superior to the laminectomy-only procedure.

Adult Intradural Extramedullary Ewing’s Sarcoma of the Lumbar Spine and Involving the Intervertebral Foramen: A Case Report

“…Due to the large extent of the lesion and the involvement of intervertebral foramen, our patient underwent posterior total laminectomy, took the screw-rod system fixation and partly bone grafting. The internal fixation not only ensured complete tumor removal, but also stabilized the spine and promoted bone graft fusion [27,28]. Chemotherapy regimens are identical for EES and ESB, including vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide [1].…”

Intraoperative Neurophysiological Monitoring for Intradural Extramedullary Spinal Tumours

“…Prior studies have shown positive outcomes for IDEM tumours regardless of IONM use, achieving gross total resection (GTR) rates of >90%, postoperative complication rates of <20%, and >80% of patients having either stable or improved neurological function at follow-up. [26][27][28][29] Even when IONM alarms have sounded intraoperatively, suggesting immediate deficit and the need to use standard measures to improve microvascular perfusion as described above, studies have found improved patient outcomes with IONM usage. 30 However, a few studies report permanent new neurological deficits as a result of surgery, regardless of IONM use.…”

“…30 However, a few studies report permanent new neurological deficits as a result of surgery, regardless of IONM use. [26][27][28][29]31,32 The good overall neurological outcomes in surgery for IDEM tumours might have been partially responsible for a high prevalence of anterolateral lesions in the non-IONM group, since patients were not randomised, the use of IONM instead being determined by surgical team preference. Furthermore, in a significant number of patients (related with preoperative ASIA score), MEPs, SSEPs or both could not be recorded.…”

Clinical Effect of Laminectomy with Lateral Mass Screw Fixation in Treating Cervical Schwannoma: A Retrospective Study

“…In addition, postoperative complications were recorded and compared. Furthermore, an analysis of patient satisfaction was performed as before [17,18], according to the questionnaire including three levels of satisfaction-very satisfied, satisfied, and dissatisfied.…”