Clinical and Biomechanical Study of Laminoplasty for Thoracic and Lumbar Intradural Tumors.

(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.

Surgical treating lumbar intraspinal tumor through a para-split laminotomy.

BACKGROUND: to explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar intraspinal tumors. METHODS: We retrospectively review the clinical data of 15 patients suffering lumbar intraspinal tumors, who underwent tumor resection using the para-split laminotomy, from October 2016 to May 2018. Observation indicators were as follows: (1) surgical and postoperative recovery situations; (2) the neurological function of the spinal cord and the follow-up situations. RESULTS: Mean blood loss was 95.3 ± 58.2 ml, and the mean duration of the surgical procedure was 176.7 ± 35.2 min. All lumbar intraspinal tumors were resected completely. There were no operative complications. The postoperative CT scans showed no pedicle or vertebral fractures. During the follow-up period of 6-18 months (average 10.8 ± 3.9 months), no tumor recurrence or spinal deformation was found according to the imaging examination. CT 3D reconstructions showed that the split laminae tended to heal. The average preoperative JOA score was 15.5 ± 4.9 and the average postoperative JOA score improved to 24.0 ± 3.5 (average improvement rate 65.9 ± 19.6%). CONCLUSION: The para-split laminotomy could reduce the damage to the posterior spinal tension band and help to protect the stability of the spine. It is feasible and effective to apply the para-split laminotomy to the operation of a lumbar intraspinal tumor, and this technique may be a promising option when considering surgical methods for some multilevel well-circumscribed intraspinal tumors.

Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series.

OBJECTIVE: This study was performed to introduce posterior laminectomy and pedicle screw fixation for the treatment of upper cervical spinal cord tumors and investigate the curative effects. METHODS: Eighteen patients (11 men, 7 women) who underwent surgical treatment of an upper cervical intraspinal tumor from January 2008 to June 2013 were reviewed. Clinical parameters including age, sex, affected spinal levels, lesion location, duration and type of symptoms, and pathological features were retrospectively investigated. RESULTS: The mean operation time was 181.9 ± 25.5 minutes (range, 135-240 minutes), and the mean blood loss volume was 1038.9 ± 284.2 mL (range, 750-1530 mL). The Frankel grade, Japanese Orthopaedic Association score, and Karnofsky performance status score were significantly better postoperatively than preoperatively. The radiographic examination revealed good bone graft fusion. Two patients developed tumor recurrence, while four patients developed intraoperative or postoperative complications. CONCLUSIONS: Management of upper cervical intraspinal tumors by posterior laminectomy and pedicle screw fixation can relieve compression of the cervical cord and nerve root, thoroughly remove the tumor lesion, reconstruct the stability of the upper cervical spine, and improve patients' quality of life.

Microsurgical Resection of Intraspinal Benign Tumors Using Non-Expansile Tubular Access.

BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.

Imaging of Intraspinal Tumors.

Nonosseous spinal tumors are rare and encompass a wide range of benign and malignant masses. Compartmental localization of the mass to the intramedullary, intradural extramedullary, or extradural spaces can narrow the differential of possibilities. Ependymomas and astrocytomas are the most common intramedullary masses. Nerve sheath tumors and meningiomas are the most common intradural extramedullary tumors, and nerve sheath tumors dominate the nonosseous extradural tumors. These tumors and other less common masses are described in this article through a space-based approach.

Teratoma of the spinal cord in an adult: Report of a rare case and review of the literature.

Teratomas of the spinal cord are incredibly rare, comprising less than 0.5% of all spinal cord tumors. These tumors are exceptionally rare in adults, with only a handful of cases reported in the literature. We present the case of a 49-year-old gentleman with new onset urinary incontinence who presented with a large intradural tumor of the thoracolumbar spine. The patient underwent a laminectomy with midline durotomy for subtotal tumor resection. Surgical pathology diagnosed the tumor as a mature teratoma, exhibiting the presence of all three germ layers. These tumors tend to present with an indolent onset of symptoms characteristic of the tumor location within the spinal cord and the affected surrounding nerve roots. Magnetic resonance imaging (MRI) is useful in determining the location and nature of these tumors, but final diagnosis ultimately rests on histopathological analysis. Surgical resection is the preferred treatment, with subtotal resection being favored if there is a high risk of intraoperative neurological damage due to adherent or infiltrative tumor. In general, the prognosis for these tumors is good, with most patients exhibiting stable or improved neurological status after resection.

Meningioma cervicotoracico resistente al tratamiento quirurgico. Presentacion de un caso y revision de la bibliografia / Cervicothoracic meningioma refractory to surgical treatment. Case report and literature review

Presentamos el caso de un hombre de 60 años con signos clínicos de mielopatía cervical de un año de evolución, dolor cervicodorsal intenso (estadio B de Frankel, grado V de Nurick), en el momento de nuestro primer examen. Trae una resonancia magnética que informa un tumor cervicotorácico compatible con meningioma. El paciente requería una rápida resolución quirúrgica y exéresis. Si bien el tiempo entre la presentación clínica inicial y el diagnóstico preliminar de meningioma por resonancia magnética está dentro de lo estipulado en la bibliografía, creemos que esta enfermedad se podría haber diagnosticado y tratado de forma más temprana. Llegamos a la conclusión de que el diagnóstico tardío sumado a las limitaciones en el sistema de salud pública actual han contribuido al resultado final poco satisfactorio, ya que luego de la resección tumoral, la liberación medular y la estabilización con material quirúrgico, aunque el resultado inmediato fue satisfactorio, no se logró un buen resultado funcional a largo plazo, porque el paciente no recuperó la función motora ni sensitiva, sólo se logró que la mielopatía no progresara y el paciente no sufra más dolor.

We report the case of a 60-year-old man with clinical signs of cervical myelopathy during a year, intense cervicodorsal pain (Frankel B stage, Nurick grade V), at the moment of our first examination. He shows a magnetic resonance study reporting cervicothoracic tumor compatible with meningioma. The patient required a quick surgical resolution and excision. Although the time between the initial clinical presentation and the preliminary diagnosis of meningioma by magnetic resonance imaging is within that reported in the literature, we believe that this disease could have been diagnosed and treated earlier. We conclude that late diagnosis added to the limitations in the current public health system have contributed to the unsatisfactory outcome, because after tumor resection, spinal release and stabilization with surgical material, immediate results were successful, but the patient did not obtain a long-term good functional outcome, because he did not recover motor and sensory function, we only avoided myelopathy progression and pain.

Approaches in intraspinal tumors resection and the reconstruction of spinal stability postoperatively / 国际外科学杂志

Intraspinal tumors with kinds of pathological type are common in clinic, whose first option of the treatment is the surgical resection.In recent years, neurosurgeons pay more attention to the postoperative stability of spine biomechanics on the basis of the total resection of the tumors.This paper reviews the approaches in intraspinal tumors resection and the methods of the reconstruction of spinal stability postoperatively which influence the stability of spine biomechanics most.

Diagnosis and surgical treatment of intraspinal tumors / 中国组织工程研究

To investigate the diagnosis and surgical treatment of inraspinal tumors. The clinical data of 246 patients with inraspinal tumors who had undergone operations in the Affiliated Hospital of Qingdao University Medical Col ege between January 2010 and January 2013 were retrospectively analyzed. The treatment and prognosis of inraspinal tumors were reviewed. 262 operations were performed, with posterior bilateral laminectomy approach in 202 cases, semi-laminectomy approach in 28 cases, laminoplasty approach in 10 cases, and lateral resection of extra-vertebral canal dumbbel shaped tumors in 22 cases. The short-term remission rate of the nerve root pain reached 95.0%(133/140), and the improvement rates of the sensory disability, motor disturbance, and sphincter dysfunction were 85.6%(125/146), 86.7%( 136/157), and 84.6(11/13) respectively. The ASIA nervous function scores and grades at the last fol ow-up were significantly superior to those before and 3 months after the operation in 236 patients. Intraspinal tumors are mostly benign. The clinical appearance of them should be watched closely, and thorough physical check-up should be performed. MRI is the examination of choice at early diagnosis. The key to improve the treatment effects is to perform operations as soon as possible.

Application of methylene blue staining in operation of intraspinal tumors / 局解手术学杂志

Objective To explore the application value of preoperative methylene blue staining in locating for the operation of intraspi-nal tumors. Methods The clinical data of patients with intraspinal tumors from September 2010 to September 2012 in our hospital were ret-rospectively analyzed. The patients were divided into tag group and control group according to whether stained by methylene blue or not. The operation time( min) ,intraoperative hemorrhage,the rate of total resection of tumor,spinal instability rate,tumor recurrence rate,and reopera-tion rate of two groups were compared. Results The operation time of tag group was significantly shorter than that of the control group. The amount of intraoperative bleeding was significantly less than that of in control group, the differences were statistically significant(P<0. 05). The total resection rate of tumor was significantly higher than that in control group,the differences were statistically significant(P<0. 05). The spinal instability rate,tumor recurrence rate and operation rate of patients within 1 year in two groups were not significant. Conclusion The methylene blue method is simple and convenient,and provides favorable conditions for the operation,which reduces the operation time and intraoperative hemorrhage,increases the rate of complete tumor resection. There was no difference in recurrence rate,operation rate and the stability of the spine within 1 year compared to traditional method.

Diagnosis and treatment of intraspinal tumors / 中国医师进修杂志

Objective To summarize the experiences of the diagnosis and treatment of the intraspinal tumors. Methods One hundredand twenty-three cases of the intraspinal tumors were analyzed retrospectively. Results The intraspinal tumors in those patients included meningiomas/neurofibroma in 32 cases (19.5%), neurinoma in 32 cases (26.0%), ependymoma in 8 cases (6.5%), astrocytoma in 13 cases (10.6%), lipoma in 10 cases (8.1%), metastatic tumors and hemangioma each in 5 cases (4.1%), arachnoid cyst in 9 cases (7.3%), and others in 17 cases (13.8%). The extramedullary subdural, epidural and intramedullary tumors accounted for 56.9%, 21.1% and 22.8%. According to the locations, 30.1% tumors located at cervical region, 37.4% at thoracic region, 19.5% at lumbar region and 13.0% at sacral segments. The total removal rates of tumors were 69.1% (the total removal rates of extramedullary tumors were 70.1%, and the removal rates of intramedullary tumors were 60.7%).The improvement rates of different degree of movement, sense and sphincter function were 75.2%, 73.8% and 77.8%. Conclusion Most of the intraspinal tumors are benign, and the surgical outcome is satisfied. The keys of therapeutic efficacy were MRI and microsurgical techniques application. The spinal stability reconstruction is in the extreme need if spinal stability is breached in surgery.