Minimally invasive approach for the treatment of intradural spinal pathology

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>A wide variety of spinal intradural pathology traditionally has been treated from a midline posterior laminectomy using standard microsurgical techniques. This approach has been successful in treating the pathology; however, it carries a risk of postoperative complications including CSF leakage, wound infection, and spinal instability. The authors describe a minimally invasive surgical (MIS) approach to treating spinal intradural pathology with a low rate of postoperative complications.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Through a retrospective review of a prospectively collected surgical database, the authors identified 26 patients who underwent 27 surgeries via an MIS approach for intradural pathology of the spine. Using a tubular retractor system and an operative microscope, the authors were able to treat all patients with a unilateral, paramedian, and muscle-splitting technique. They then collected data regarding operative blood loss, length of stay, imaging characteristics, and outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eight cervical, 8 thoracic, and 11 lumbar intradural pathological entities, which included 14 oncological lesions, 4 Chiari I malformations, 4 arachnoid cysts, 3 tethered cords, 1 syrinx, and 1 chronic visceral pain, were treated via an MIS approach. The average blood loss was 197 ml and the average hospital stay was 3 days. One patient had to return to the operating room for noninfectious wound dehiscence. One patient required reoperation 18 months after the initial surgery for recurrence of the initial pathology. There was no CSF leak, no infection, and no spinal instability associated with the initial surgery on follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Intradural spinal pathology can be safely and effectively treated with MIS approaches without an increased risk of neurological injury. This approach may also offer a reduced postoperative length of stay, risk of CSF leak, and risk of future spinal instability.</jats:p></jats:sec>

The Optimal Surgical Approach to Intradural Spinal Tumors: Laminectomy or Hemilaminectomy?

“…While not statistically significant, there was a trend towards a reduction in blood loss in the hemilaminectomy group compared to the laminectomy group. This result was in contrast to published reports which showed a reduction in blood loss when utilizing MIS techniques for hemilaminectomy [14,21]. This finding suggests that the level of bony resection is not the major source of blood loss in these cases, and that the approach to the spine, MIS techniques versus open, may play a larger role in reducing total blood loss.…”

“…Recent trends towards MIS techniques and cost-effective utilization of limited hospital resources have introduced questions regarding which surgical approaches should be used to access spinal pathologies. Moreover, multiple studies have confirmed the potential for reduced estimated blood loss, and lower length of hospital stays with MIS techniques [1,5,8,[14][15][16][17]20]. These favorable results are typically attributed to the minimal disruption of the posterior tension band with little mention of the effects of the extent of bony resection.…”

“…The hemilaminectomy technique minimizes the bony removal and allows for preservation of the spinous process, the contralateral zygapophyseal joints, and the contralateral paraspinal musculature, which could potentially reduce the risk of postoperative instability, kyphosis, and pain [3,5,8]. Recent data have demonstrated positive clinical outcomes with respect to blood loss, complications, length of hospital stay, operative time, and most importantly post-operative instability when utilizing a hemilaminectomy approach [11][12][13][14][15][16][17][18]. However, it remains unclear if these benefits are due to the reduced bony resection or the utilization of minimally invasive surgical (MIS) techniques compared to open surgery.…”

Endoscopic Management of Spinal Intradural Extramedullary Tumors

“…Minimally invasive approaches for intradural tumors have been found to be safe and effective. [1][2][3][4][5] A microscope 6 or endoscope 7 has been used recently in such cases. Minimally invasive surgical (MIS) approaches using expandable or nonexpandable tubular retractor 8 or interlaminar approaches 9 have been described to reduce trauma-related instability with comparable outcome.…”

Endoscopically-controlled surgery with open hemi-laminectomy for the treatment of intradural extramedullary tumors: An operative technique and short-term outcomes of 20 consecutive cases

“…Nevertheless, surgical reports demonstrated its preferred use for small and laterally located masses. Several previous studies have attempted to improve various aspects of bone work required during hemi-laminectomy to gain more exposure for the tumor resection [3,9,10].…”