Postoperative functional outcome of intradural extramedullary spinal tumors through posterior approach

Objective: To determine functional outcome of intradural extramedullary spinal tumors in patients undergoing excision through the posterior approach alone

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Study Design: Interventional study

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Place and Duration of Study: Neurosurgery Department, JPMC, Karachi, from March 2011 to February 2014

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Methodology: Patients with intradural extramedullary spinal tumors [IDEM], confirmed on MRI, were admitted through Outpatient Department. Those with bleeding disorders, diabetes mellitus, previously operated and with no histopathological evidence of tumor on biopsy, were excluded. Clinical signs, symptoms and location of the tumor were noted. These patients then underwent laminectomy and excision of tumor through the posterior approach, regardless of the location or type of tumor. Transpedicular screw was placed where the tumor was so large, as to cause posterior instability. The functional outcome was evaluated by assessment of Medical Research Council [MRC] Scale for Muscle Strength preoperatively and at 6 months follow-up postoperatively. Good outcome was labelled when there was improvement from previous grade before surgery to higher grade, as assessed by muscle strength on follow-up at 6 months after surgery

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Results: The mean age of the 38 patients was 42.6 +/- 10 years. Majority were females [68.42%]. Meningioma was the commonest tumor [63.15%]. The commonest location was thoracic spine [73.68%]. Backache was present in all [100%] patients, motor weakness in 30 [78.92%] patients, sensory disturbance in 5 [13.5%] patients, sphincter disturbance in 7 [18.42%] patients, and shortness of breath in 1 [2.63%] patient. Preoperatively, there were 10 patients [26.31%] in grade 3, 9 [23.68%] patients in grade 0, 8 [21.05%] in grade 1, 7 [18.42%] patients in grade 2. After 6 postoperative months, there were 23 [60.52%] patients in grade 5, 5 [13.15%] patients in grade 3, 5 [13.15%] patients in grade 2 and 2 [5.26%] patients in grade 1. Postoperative complications were CSF leak, respiratory distress, wound infection and incontinence

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Conclusion: Functional outcome of intradural extramedullary spinal tumors was found to be good