Microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty for treatment of spinal canal schwannoma: a report of 18 cases

Abstract

Objective To explore the curative effect of the microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty for the treatment of spinal canal schwannoma. Methods The clinical data of 18 patients with spinal schwannomas, admitted to our hospital from September 2011 to June 2014, were analyzed retrospectively. All these 18 patients were treated by microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty, and were followed up for 3-18 months (mean: 10 months). After the surgery, vertebral canal MRI was adopted to evaluate the tumor, and CT three-dimensional reconstruction or X-ray of the spine was used for assessing the vertebral canal formation, and Frankel grading standard was employed to evaluate the recovery of spinal cord function. Results All tumors in 18 patients were excised with the help of a microscope, and no endorachis and nerve roots were damaged during the surgery. After the surgery, the patients showed significantly improved symptoms and signs without the leakage of cerebrospinal fluid, infection of incisional wound, tumor recurrence, spinal stenosis and spinal instability. At 3 months after the surgery, Frankel grading standard was adopted to assess the recovery of the spinal cord function, and the results showed grade D in 4 patients and grade E in 14 patients. Conclusion Microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty is an effective way in treating spinal canal schwannoma as it can completely expose the tumor, maximize the excision extension and decrease the spinal cord injury; meanwhile, the spinal canal is formed well and the spine is stable after the surgery. Key words: Microsurgery; Spinous process and vertebral plate complex; Lamina plasty; Schwannoma