ABSTRACT
Objective:To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods:Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors, who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to August 2019, including 16 males and 19 females, and the age was(40.1±10.6)years. Intraoperative blood loss, operation time, tumor resection, tumor pathological results, perioperative complications were observed. Follow-up situations, including tumor recurrence, bony fusion of laminae and spinal stability. Follow-up using outpatient examination and telephone interview was performed by the end of August 2022. The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord, and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores. Linear regression and multiple linear regression were used to analyze the prognostic factors. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and the comparison before and after operation was performed by paired t-test. Mearsurement data of skewed distribution were expressed as M( Q1, Q3). Count data were expressed as cases. Results:The tumors of 35 patients were resected completely. The median blood loss was 100(75, 140)mL and the average operative duration was (181.1±42.7) min. The postoperative pathological results were as follows: 24 neurilemmomas, 6 meningiomas, 4 ependymomas and 1 neurofibroma. There were no surgery-related complications occurred. The postoperative follow-up ranged from 36 to 69 months, with no tumor recurrence or spinal instability, and bony fusion of laminae seen in some patients on CT imaging. The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2), Paired t-test analysis revealed a significant difference between the overall postoperative spinal cord neurological function scores and the preoperative scores, and the postoperative scores were better than the preoperative scores( P<0.05). Multiple linear regression analysis showed a positive correlation between preoperative JOA scores and postoperative JOA scores, and postoperative JOA scores has negative correlation with tumor volume and the age at the time of operation ( P<0.05). Conclusion:Para-split laminotomy with less damage to the posterior spinal structures can effectively improve the neurological function of the spinal cord and protect the stability of the lumbar spine in patients with lumbar spinal canal tumors, and the better the preoperative neurological function of the spinal cord, the better the prognosis of patients, and the smaller the tumor volume, the better the prognosis.
ABSTRACT
Objective: To explore the effect of continuous saline irrigation and cooling during posterior lumbar surgery using high-frequency electric knife to expose lumbar lamina on postoperative incision pain. Methods: A total of 34 adult patients with lumbar intraspinal tumor were included in present study who received surgical treatment from August 2017 to July 2018 in Changzheng Hospital Affiliated to Navy Medical University, and were randomly divided into irrigated group (n=17) and nonirrigated group (n=17). Patients in irrigated group received continuous normal saline irrigation for cooling surgical field, while those in non-irrigated group did not receive such treatment. The time required for exposure of bilateral lamina, the temperature of tissues around the electrosurgical scalpel, degree of thermal damage of muscle tissue, postoperative C-reactive protein level, the visual analogue scale (VAS) scores at 1st, 2nd and 3rd day after operation, and the amount of analgesics were compared between the two groups. Results: The time required for exposure of bilateral lamina was obviously longer in irrigated group than in nonirrigated group [(29.12±4.68) min vs. (24.94±3.23) min, P0.05) between the two groups. The VAS score and the amount of analgesics were obviously lower in irrigated group than in non-irrigated group at the 1st day after operation (P0.0.5) at the 2nd and 3rd day after operation. Conclusion: Continuous normal saline irrigation may reduce the thermal damage of muscle tissue to some extent after posterior lumbar surgery, and relieve the postoperative pain.