Clinical effects and mid-term follow-up analysis of para-split laminotomy for lumbar spinal canal tumors / 国际外科学杂志

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.

Safety and efficacy of tranexamic acid in spinal canal tumors: a retrospective cohort study.

Objective: The use of tranexamic acid (TXA) has become popular in spinal surgery, the purpose of this study is to investigate the effectiveness and safety of intraoperative TXA used to reduce surgical bleeding and transfusion requirements in spinal canal tumor resection.Methods: The data for patients with spinal canal tumors treated in our hospital from June 2014 to June 2017 were collected. The patients (≥18 years of age) were divided into a TXA group (group A, n = 30) and a non-TXA group (group B, n = 30). The TXA dose regimen in group A comprised a loading dose of 10 mg/kg 30 minutes before the operation, followed by a maintenance dose of 1 mg/kg per hour during the operation. Group B was not given TXA. The operation time, intraoperative blood loss, postoperative drainage, postoperative complications, coagulation function such as plasma thrombin time(PT), prothrombin time(TT), activated thromboplastin time(APTT), fibrinogen (Fib) were statistically analyzed.Results: The intraoperative blood loss and postoperative drainage volume were significant lower in group A than in group B (p<.05). There were no significant differences in the operation time, plasma thrombin time, prothrombin time, activated thromboplastin time, or fibrinogen between the two groups before and after the operation (p>.05), and no thrombotic complications occurred.Conclusion: TXA used during spinal tumor surgery can reduce the amount of intraoperative blood loss and postoperative drainage without increasing the risk of deep vein thrombosis and related complications.

Effect of continuous saline irrigation during operation on the incision pain relief after posterior lumbar surgery / 解放军医学杂志

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.

[A retrospective study of factors influencing incision healing time in postoperative patients with spinal canal tumors].

Objective: To explore the factors influencing incision healing time in postoperative patients with spinal canal tumors. Methods: The clinical data of 116 patients with spinal canal tumors (60 males and 56 females, with an average age of 44±16 years) in neurosurgery department of Henan People's Hospital from December 2017 to February 2019 were retrospectively analyzed. The influencing factors of incision healing time were analyzed by Logistic regression. Results: Univariate analysis showed that limb muscle strength (P=0.011), the location of tumors (P=0.031), indwelling catheters (P=0.029), spinal neural function (P=0.000), Types of spinal canal tumors (P=0.006) , Diabetes (P=0.043) ,BMI (P=0.001) , Length of surgical incision (P=0.006) ,Cerebrospinal fluid leakage (P=0.001) , the operation duration (P=0.002) presented statistical significance; Logistic regression analysis showed that there were significant differences in Types of spinal canal tumors (P=0.038) , Length of surgical incision (P=0.000) , Cerebrospinal fluid leakage (P=0.004) , spinal neural function (P=0.002) and the operation duration (P=0.046). Conclusions: Extremity muscle strength, the location of tumors, indwelling catheters, the operation duration, spinal neural function, Types of spinal canal tumors, Diabetes, BMI, Length of surgical incision, Cerebrospinal fluid leakage were influencing factors of incision healing time in postoperative patients with spinal canal tumors; Among which Types of spinal canal tumors, Length of surgical incision, Cerebrospinal fluid leakage, Spinal neural function and The operation duration were independent influencing factors.

Microsurgery for spinal canal tumors: A clinical analysis of 145 cases / 第二军医大学学报

Objective: To explore the microsurgical treatment of spinal canal tumors and to analyze the strategies for clinical treatment of spinal canal tumors. Methods: Were retrospectively analyzed the clinical data of 145 patients with spinal canal tumors who were treated in our hospital from Dec. 2014 to Nov. 2016. Microscopic resection of tumors was performed with half lamina-, full lamina-, or lamina joint-fenestration. Spinal internal fixation was performed in 52 patients. The patients were followed up for 3-26 months. X-ray and magnetic resonance imaging were performed again in all patients, and computed tomographyed was performed in patients undergoing internal fixation. The spinal cord function was assessed by McCormick grade before operation, 1 week after operation and 3 months after operation. Results: Of the 145 patients, 127 underwent total resection, 16 underwent subtotal resection and 2 underwent partial resection. One patient with cervical intramedullary tumors developed kyphosis after operation and underwent reoperation. No screw rod dislocation or spine instability was found in the 52 patients undergoing spinal internal fixation. The McCormick grading was significantly better 1 week and 3 months after operation versus before operation (P<0.05). Conclusion: Microsurgery is an effective method for treatment of spinal canal tumors. Good intraoperative exposure and reliable spinal internal fixation are essential to reduce the complications after spinal canal tumor surgery.

Regrafting the posterior ligamentous complex to reconstruct the spinal stability after spinal canal tumor resection / 局解手术学杂志

Objective To observe the spinal stability of regrafting the posterior ligamentous complex after spinal canal tumor resection. Methods The data of 43 cases with spinal canal tumor in our department from July 2008 to July 2013 were retrospectively analyzed,who were fixed the free of the lamina by mini titanium-plate. Results The operation time was 130 to 220 min,the average time was 150 min. The blood loss volume was 200 to 750 mL,with average volume 340 mL. All patients were followed up for 6 to 42 months. No iatrogenic spinal cord injury nor complications such as artery injury,spinal cord and spinal nerve root local anomalies hydrops occurred. By Flexion-extension radio-graphs,regrafting of the posterior ligamentous complex after the resection of spinal cord tumors preserved spinal mobility well. Conclusion The mini titanium-plate fixation treatment of spinal canal tumor has good superiority and clinical feasibility by regrafting the posterior ligamen-tous complex and reconstructing the spinal stability.

Surgical treatment of intradural tumor / 中国矫形外科杂志

[Objective]To investigate results of surgical treatment of intradural tumors of the cervical spinal cord.[Method]Twenty-one cases with cervical intradural tumor were treated surgically under posterior approach from 1999 to 2005,all patients were performed cervical laminae resection before tumor resection,and some received internal fixation.All patients were followed up for 8 months to 38 months respectively.All the clinical materials were analyzed retrospectively.[Result]All patients survived the operation,symptoms disappeared 13,relieved 7 and deteriorated 1.Total resection in 15 cases,subtotal 4 cases and partial 2 cases.[Conclusion]To succeed the operation,it is very important to make clear the location and size of the tumor and the relationship between the tumor and spinal cord;in order to gain total resection of tumor,both careful protection of spinal cord and vertebral artery and intraspinal cannal veins are essence.