Treatment results in the different surgery of intradural extramedullary tumor of 122 cases.

Shaohui Zong,Li Du,Gaofeng Zeng,Ye Fang,Taihang Gao,Jingmin Zhao,Zachary A Smith

doi:10.1371/journal.pone.0111495

Shaohui Zong, Li Du + Show 5 more

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https://doi.org/10.1371/journal.pone.0111495

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Abstract

Study DesignA retrospective study of intradural extramedullary tumor.ObjectiveTo compare the treatment results in the different surgeries of spinal intradural extramedullary tumor.MethodsThe study retrospectively reviewed 122 patients. The minimally invasive surgery (MIS) group was divided into Group A (hemilaminectomy + tumor microscopic excision) and Group B (laminectomy + tumor microscopic excision + pedicle screw fixation). Meanwhile, the non-MIS group was divided into Group C (hemilaminectomy + tumor excision), Group D (laminectomy + tumor excision), and Group E (laminectomy + tumor excision + pedicle screw fixation). In order to study postoperative spinal stability, we simultaneously divided all of the subjects into three categories, namely Group HE: hemilaminectomy + tumor excision; Group LE: laminectomy + tumor excision; and Group LEPSF: laminectomy + tumor excision + pedicle screw fixation.ResultsThe MIS group exhibited fewer postoperative complications (p<0.05), better short-term clinical efficacy (p<0.05) and less non-surgical cost (p<0.05) than in non-MIS group. The rate of postoperative spinal instability in hemilaminectomy was lower than in laminectomy in a single spinal segment (p<0.05). The rate of postoperative spinal instability in laminectomy + pedicle screw fixation was lower than in hemilaminectomy and laminectomy in two or more spinal segments (p<0.05).ConclusionIn the case of appropriate surgical indications, minimally invasive surgery for intradural extramedullary tumor is a useful method that can successfully produce good clinical results and reduce non-surgical cost. In addition, pedicle screw fixation helps avoid spinal postoperative instability.

Highlights

Intradural extramedullary tumors are very common in the osteopathic departments, accounting for approximately two-thirds of all primary intraspinal neoplasms [1]
This study reviewed a series of 53 consecutive patients with spinal intradural extramedullary tumors who underwent minimally invasive surgery (MIS) and 69 consecutive patients with spinal intradural extramedullary tumors who underwent non-MIS
The following inclusion criteria were used: 1) all of the subjects had intradural extramedullary tumor; 2) all of the subjects exhibited integrity of the spine and spinal stability before surgery; 3) clinical diagnosis was determined by physical examination, magnetic resonance imaging (MRI), and pathology; and 4) clinical and radiological follow-up was carried out for 12–60 months

Summary

Introduction

Intradural extramedullary tumors are very common in the osteopathic departments, accounting for approximately two-thirds of all primary intraspinal neoplasms [1]. The primary goal of the therapy for spinal intradural tumors is to decompress the spinal cord and remove it thoroughly without recurrence. Surgery is the effective approach for benign intradural extramedullary tumors [3]. Minimally invasive surgery for benign intradural extramedullary tumor removal still represents the best therapeutic option [4,5]. A conventional approach without a microscope can have a good curative effect, several drawbacks still exist, including greater intraoperative blood loss and a higher risk of injury to the spinal cord or nerve roots. When removing spinal intradural extramedullary tumors by MIS or non-MIS, the damage to the anatomical structure of the posterior column of the spine will affects postoperative spinal stability

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