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Zilong M, Jinan Z, Weixin L, Peng W, Wei Z. Comparison of the surgical outcomes of the posterior approach, video-assisted thoracic surgery, and combined approach for thoracic dumbbell tumors based on a new classification: a retrospective study. Neurosurg Rev 2024; 47:29. [PMID: 38167736 PMCID: PMC10761486 DOI: 10.1007/s10143-023-02267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
The appropriate surgical treatment strategy was based on the regions of tumor invasion. There is no classification to aid the surgeon in selection. A retrospective study of the clinical data of patients who underwent resection of thoracic dumbbell tumors at the Neurosurgery and Thoracic Surgery Department of Hospital between January 1, 2016, and December 31, 2021 was conducted. Patient data, images, and surgical outcome data were collected. The thoracic spine was divided into areas A, B, and C with respect to the line through the middle of the intervertebral foramen and the line of the costo-transverse joint lateral margin in the horizontal plane. Type I tumors were located in areas A or A and B, type II tumors were located in areas B or B and C, and type III tumors were located in areas A, B, and C. Fifty-five patients with thoracic dumbbell tumors were surgically treated (mean age, 43.1 years; 22 (40%) female). The patients with type I and III tumors underwent the posterior approach, type III tumors had more bleeding during the operation and longer operation times than type I. Among the patients with type II tumors who underwent video-assisted thoracic surgery and the posterior approach, the posterior group had more bleeding and a longer operation time than the others. The patients with type III tumors underwent the combined approach and the posterior approach; although there was no clear difference in the bleeding volume or operation time, the combined approach group had a lower incidence of complications. The new classification of different types of thoracic dumbbell tumors can simply and effectively guide the selection of surgery.
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Affiliation(s)
- Mao Zilong
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China
| | - Zhang Jinan
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Li Weixin
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Wang Peng
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Zuo Wei
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China.
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Okubo T, Nagoshi N, Tsuji O, Ozaki M, Suzuki S, Takahashi Y, Matsumoto M, Nakamura M, Watanabe K. Impact of Surgical Resection Without Spinal Fusion for Thoracic Dumbbell Tumors on Postoperative Global Spinal Sagittal Alignment and Clinical Outcomes. Global Spine J 2023:21925682231212724. [PMID: 37899599 DOI: 10.1177/21925682231212724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVES This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors. METHODS Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine). RESULTS The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups. CONCLUSIONS Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ishikawa Y, Ohashi M, Hirano T, Matsuda M, Akabane T, Kanno H, Hashimoto K, Handa K, Aizawa T, Suzuki T, Shimamura Y, Watanabe K. Mid- to Long-Term Outcomes After Resection of Thoracic Dumbbell Tumors Managed by Laminectomy and Unilateral Total Facetectomy Without Instrumented Fusion. Global Spine J 2023; 13:771-780. [PMID: 33973481 DOI: 10.1177/21925682211008836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE To evaluate mid- to long-term surgical outcomes of thoracic dumbbell tumors managed by laminectomy and unilateral total facetectomy without instrumented fusion. METHODS A total of 15 patients with thoracic dumbbell tumors who underwent primary resection by laminectomy and unilateral total facetectomy without spinal instrumented fusion between 2000 and 2015 were reviewed. Patient characteristics, surgical outcomes (including spinal alignment and stability), disc degeneration, pain, disability, and health-related quality of life were evaluated. Additionally, to analyze the impact of the affected levels on these outcomes, we divided the patients into 2 groups: a middle thoracic group and a thoracolumbar group. RESULTS The mean duration of follow-up was 100.5 months (range, 36-190 months). The affected level was T3-T4 or below in all patients. Although the local kyphosis angle (8.1° to 12.7°), thoracic kyphosis angle (25.6° to 33.9°), and coronal Cobb angle (6.6° to 9.5°) significantly increased from preoperative to the final visit (P ≤ .02), no patient demonstrated spinal instability. From magnetic resonance imaging, no patient had a worse grade of disc degeneration in the affected level than those in the adjacent levels. The percentage of patients who presented with an Oswestry disability index ≤ 22% was 80%. Moreover, the surgical region did not adversely affect the outcomes. No patient required additional surgery due to spinal instability or deformity. CONCLUSIONS Unilateral total facetectomy without fusion to resect thoracic dumbbell tumors caused neither spinal deformity nor instability requiring additional surgery at the mid- to long-term follow-up.
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Affiliation(s)
- Yuya Ishikawa
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Michiharu Matsuda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeru Akabane
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kyoichi Handa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoto Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yukihide Shimamura
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kei Watanabe
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Jiang YW, Xu XJ, Wang R, Chen CM. Tubular minimally invasive resection of McCormick type II paraspinal schwannoma: preliminary experience. Br J Neurosurg 2023; 37:193-198. [PMID: 35379043 DOI: 10.1080/02688697.2022.2057433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Complete removal of paraspinal schwannomas is generally required for full patient recovery. However, traditional open approaches to surgery are often extensive and may lead to more postoperative complications. Herein, we present our preliminary experience with tubular minimally invasive resection of McCormick type II paraspinal schwannomas and describe the technique by specifically reviewing two patient cases. MATERIALS AND METHODS Type of study: Retrospective: Level of evidence: Level III: A total of 15 patients (six men; nine women; median age, 45 years) who underwent minimally invasive resection of McCormick type II paraspinal schwannomas were retrospectively analysed. Preoperative characteristics, including age, location of tumour, Visual Analog Scale score, Modified McCormick Scale score, and intraoperative findings and complications were analysed. Furthermore, postoperative outcomes using imaging, such as magnetic resonance imaging (MRI) and thin-slice computed tomography, and postoperative neural status using the Modified McCormick and Visual Analog Scales were also assessed. RESULTS The mean operation time was 134.72 ± 34.21 min. The estimated mean blood loss and mean hospital stay were 25.33 ± 17.27 ml and 7.67 ± 1.88 days, respectively. Regarding complications, one of the patients had a local wound infection, which improved after antibiotic treatment. The total resection in all cases was verified using postoperative MRI. CONCLUSION The tubular minimally invasive approach is a feasible technique for the total resection of McCormick type II paraspinal schwannomas. Using this technique, surgeons can resect paraspinal schwannomas while maintaining spinal stability.
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Affiliation(s)
- Yan-Wei Jiang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Xiong-Jie Xu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
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Pan J, Gu Y, Zhang F. One step excision combined with unilateral transforaminal intervertebral fusion via minimally invasive technique in the surgical treatment of spinal dumbbell-shaped tumors: A retrospective study with a minimum of 5 years’ follow-up. Front Surg 2022; 9:939505. [PMID: 36176344 PMCID: PMC9513348 DOI: 10.3389/fsurg.2022.939505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSpinal dumbbell-shaped tumors are rare, usually benign tumors with intraspinal and paravertebral components connected through intervertebral foramen. Complete excision is often performed through traditional open surgery (TOS). The efficacy and long-term outcomes of minimally invasive surgery (MIS) have not been reported to date in resection of dumbbell-shaped spinal tumors.PurposeThe purpose was to evaluate the efficacy and long-term outcomes of minimally invasive resection combined with unilateral transforaminal intervertebral fusion (TIF) through comparing with TOS in the treatment of spinal dumbbell-shaped tumors.MethodsFifteen patients underwent MIS and 18 patients underwent TOS. Thoracic dumbbell-shaped tumors were directly exposed after removal of costotransverse joints, adjacent rib components, unilateral hemilamina, and facet joints. Lumbar dumbbell-shaped tumors were completely exposed after removal of transverse processes, unilateral hemilamina, and facet joints. Whether for minimally invasive resection or traditional open removal, dumbbell-shaped tumors were completely excised and unilateral TIF was performed to guarantee spinal stability. All patients were followed up for 5 years at least.ResultsThe mean length of surgical incision for two groups was 3.47 ± 0.37 vs. 6.49 ± 0.39 cm (p < 0.05). The average duration of the operation was 131.67 ± 26.90 vs. 144.17 ± 23.59 min (p > 0.05). The mean blood loss was 172.00 ± 48.79 vs. 285.83 ± 99.31 ml (p < 0.05). No blood transfusions were required in the two groups. The median length of hospitalization was 6 vs. 10 days (range: 5–8 vs. 7–14 days). The patients of two groups were monitored for an average of 65.93 ± 3.88 vs. 65.78 ± 3.56 months. At 5-year follow-up, all patients presented with normal neurological function (American Spinal Injury Association scale E). The Oswestry Disability Index in the MIS group decreased significantly more than the TOS group. No spondylolisthesis or spinal instability were found in the follow-up period. There was no recurrence of any spinal tumor 5 years after surgery.ConclusionsSpinal dumbbell-shaped tumors can be safely and effectively treated with minimally invasive resection combined with unilateral TIF. Compared with TOS, MIS offers a reduced length of surgical incision, blood loss, hospital stay, and postoperative pain. This surgical protocol might provide an alternative for the treatment of spinal dumbbell-shaped tumors.
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Affiliation(s)
- Jianfeng Pan
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Orthopedic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Correspondence: Yutong Gu
| | - Feng Zhang
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Joseph M. Still Burn and Reconstructive Center, Jackson, Mississippi, United States
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Zeng W, Jiang H, He S, Zhang Y, Yu B, Wang H, Wang C. Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution. Front Surg 2022; 9:823770. [PMID: 35425804 PMCID: PMC9002179 DOI: 10.3389/fsurg.2022.823770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study was designed to compare the safety and efficacy of unilateral hemilaminectomy conducted under complete neuroendoscopic visualization (UHNV) relative to unilateral hemilaminectomy under total microscopic visualization (UHMV) for the treatment of patients diagnosed with intraspinal tumors. Methods In total, 41 patients undergoing intraspinal tumor resection at Northern Jiangsu People's Hospital were included in this study, including 20 and 21 patients in the UHNV and UHMV groups, respectively. Intraoperative parameters including incision length, operative duration, number of vertebral laminae removed and intraoperative blood loss, as well as indicators of curative efficacy such as total tumor resection rates and postoperative symptom improvement rates, and safety indicators including complication rates, recurrence rates, spinal deformity rates, spinal instability incidence, and length of stay (LOS), were compared between the two groups. Results In contrast to the UHMV group, patients in the UHNV group had a significantly shorter incision length and decreased intraoperative blood loss (P < 0.05), while the operative duration (P > 0.05) showed no statistical difference. Although the postoperative improvement and total tumor resection rates were enhanced, the difference was not statistically significant (P > 0.05). In comparison, the bedridden time and length of stay (LOS) were significantly shortened (P < 0.05) in the UHNV group. However, there were no significant differences in recurrence, incidence of complications, spinal deformity, and spinal instability (P > 0.05). Conclusion Collectively, our findings indicate that UHNV is not inferior to the UHMV approach. Moreover, due to its safe and minimally invasive nature, UHNV represents a promising alternative to UHMV as a treatment for patients with intradural extramedullary tumors.
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Affiliation(s)
- Wei Zeng
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Haixiao Jiang
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Shiwei He
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yukun Zhang
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Bo Yu
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hui Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Cunzu Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Cunzu Wang
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Aoyama R, Anazawa U, Hotta H, Watanabe I, Takahashi Y, Matsumoto S. A Novel Technique of Mixed Reality Systems in the Treatment of Spinal Cord Tumors. Cureus 2022; 14:e23096. [PMID: 35296052 PMCID: PMC8917809 DOI: 10.7759/cureus.23096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/29/2022] Open
Abstract
Several reports have compared spinal cord tumor removal techniques but none have clearly described the appropriate site and level of indication for laminectomy or laminoplasty. The approach method for tumor removal depends on the type and localization of the tumor and the surgeon's skill. Therefore, a system that can suggest various surgical techniques is useful for spinal cord tumor surgery. The mixed reality system introduced in this paper is an excellent system that can suggest various surgical procedures. Using this system for spinal cord tumor removal, we made the surgery less invasive; therefore, we introduced this system and demonstrated its usefulness. Stereoscopic data of the patients with spinal cord tumors were obtained from preoperative myelogram-CT data. Stereoscopic laminectomy models including tumors were created using Blender, a free three-dimensional (3D) image editing software. We observed these data as 3D object images using a head-mounted display (HMD). This HMD is commercially available and relatively inexpensive. The surgical procedure is determined by considering those 3D images, radiological diagnosis, and the skill of surgeons. Intraoperative confirmation of the laminectomy site could be performed using the HMD. The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases. Stereoscopic images using HMDs allow us a more intuitive understanding of the positional relationship between the tumor and spinal structure. These 3D object images can bring us more accurate preoperative planning and proper determination of surgical methods.
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Martos M, Cano P, Molino JA, López-Fernández S, Hladun R, López M, Guillén G. Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach. Clin Transl Oncol 2021; 24:950-957. [PMID: 34718957 DOI: 10.1007/s12094-021-02724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Traditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option. METHODS A systematic review of the literature was conducted in PubMed (Jan 2000-Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included. RESULTS 7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant. CONCLUSION Surgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.
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Affiliation(s)
- M Martos
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Cano
- Neurosurgery Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain
| | - J A Molino
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S López-Fernández
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - R Hladun
- Pediatric Oncohematology Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain
| | - M López
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Surgery Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Guillén
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Surgery Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Analysis of techniques and curative effect of minimally invasive surgery on intraspinal extramedullary subdural tumors. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wang R, Chen Y, Liang Z, Yang W, Chen C. Efficacy of One-stage Paravertebral Approach using a Micro-Tubular Technique in Treating Thoracic Dumbbell Tumors. Orthop Surg 2021; 13:1227-1235. [PMID: 33943013 PMCID: PMC8274168 DOI: 10.1111/os.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/24/2021] [Accepted: 02/21/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the feasibility and efficacy of one-stage surgical resection of thoracic dumbbell tumors using a paravertebral approach and a micro-tubular technique. METHODS Clinical data of thoracic dumbbell tumors resected using a paravertebral approach and a micro-tubular technique (14 mm, non-expandable type) in the Department of Neurosurgery at our hospital from July 2014 to July 2019 were retrospectively analyzed. Tumors were found between T1 and T12 vertebrae. Operation time, blood loss, hospitalization, recovery of neurological function, complications, the Japanese Orthopaedic Association (JOA) score, and the visual analogue scale (VAS) score were used to evaluate clinical efficacy. RESULTS In all 31 cases, tumors were completely resected in one operation, with a mean blood loss of 53.23 ± 33.08 mL (20-150 mL) and a mean operation time of 95.16 ± 20.31 min (60-180 min). According to the Eden classification, there were four type II cases, 16 type III cases, and 11 type IV cases. The incidence of tumors in the lower thoracic segment (T8-T12) was 51.6% (16/31 cases), while the incidences in the upper thoracic segment (T1-T4) and middle segment (T5-T8) were 25.8% (8/31 cases) and 22.6% (7/31 cases), respectively. Pathological diagnoses were schwannoma (n = 22), gangliocytoma (n = 4), metastatic tumor (n = 2), neurofibroma (n = 1), granuloma (n = 1), and lipoma (n = 1). After surgery, symptoms were relieved in all patients. VAS and JOA scores significantly improved (P < 0.001). There was no pleural or lung injury, and there were no complications, such as cerebrospinal fluid leakage. The average follow-up duration was 29 months (13-59 months), during which time no tumor recurrence or spinal instability occurred. The group of Eden type II tumors had lower JOA scores at 12 months postoperatively, longer operation times, and more estimated blood loss compared with other groups (P < 0.05). There were no significant influences on VAS scores at 12 months postoperatively and postoperative hospital stay from the different types of tumors. CONCLUSION The paravertebral approach with a micro-tubular technique is a safe and effective minimally invasive surgical approach for thoracic dumbbell tumors that allows one-stage tumor resection using a single incision. Using this approach significantly reduces intraoperative blood loss and postoperative complications, shortens hospital stay, and reduces the rates of postoperative spinal instability.
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Affiliation(s)
- Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zeyan Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Yang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
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Balasubramanian SC, Nair AR, Saphiya NN, Madan A, Mathews SS. Minimally Invasive Resection of Spinal Tumors with Tubular Retractor: Case Series, Surgical Technique, and Outcome. World Neurosurg 2021; 149:e612-e621. [PMID: 33548528 DOI: 10.1016/j.wneu.2021.01.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Traditional laminectomy for excision of spinal tumors involves extensive dissection of the midline spinous ligaments, greater blood loss, and risk of delayed segmental instability. The minimally invasive technique of spinal tumor resection using tubular retractors can achieve safe and complete tumor resection while preserving the structural and functional integrity. The authors present their experience of minimally invasive spinal surgery for spinal tumors in this case series. METHODS The authors retrospectively reviewed 41 consecutive spinal tumor cases operated by the MISS-Key Hole technique using the tubular retractor system at Sree Utharadom Thirunal Hospital, Kerala, India between January 2015 and January 2020. Preoperative clinical findings, surgical technique, operative statistics, complications, and patient outcomes were analyzed in detail. RESULTS We could successfully achieve gross total resection in 39 cases (95.12%) and subtotal resection in 2 cases. There were 4 cervical, 1 craniovertebral junction, 20 thoracic, 14 lumbar, and 2 sacral lesions, of which 4 were extradural, 1 extradural foraminal, 33 intradural, and 3 dumbbell lesions. The Modified McCormick Scale at 12 weeks had improved by 1-2 scales in all but 2 patients. There was no cerebrospinal fluid leak, pseudomeningocele, or infection in our series. CONCLUSIONS This series demonstrates the feasibility, safety and effectiveness of the keyhole approach for excision of intradural and extradural spinal tumors extending up to 2 levels. Careful case selection, good preoperative planning, meticulous microsurgical resection, and watertight dural closure are crucial for successful outcome. Early mobilization, less blood loss, and avoidance of delayed instability are the advantages of minimally invasive spinal surgery when compared with open surgery.
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Affiliation(s)
| | - Ajith Rajappan Nair
- Department of Neurosurgery, Sree Utharadom Thirunal Hospital, Pattom, Thiruvananthapuram, Kerala, India.
| | - Navas Nazumudeen Saphiya
- Department of Neurosurgery, Sree Utharadom Thirunal Hospital, Pattom, Thiruvananthapuram, Kerala, India
| | - Abu Madan
- Department of Neurosurgery, Sree Utharadom Thirunal Hospital, Pattom, Thiruvananthapuram, Kerala, India
| | - Shobha Sara Mathews
- Department of Neurosurgery, Sree Utharadom Thirunal Hospital, Pattom, Thiruvananthapuram, Kerala, India
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Konakondla S, Nakhla J, Xia J, Barber SM, Fridley JS, Oyelese AA, Gokaslan ZL, Rainov NG, Haritonov DG, Wagner R, Telfeian AE. A Novel Endoscopic Technique for Biopsy and Tissue Diagnosis for a Paraspinal Thoracic Tumor in a Pediatric Patient: A Case Report. Int J Spine Surg 2020; 14:S66-S70. [PMID: 33900947 DOI: 10.14444/7167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Conventional approaches to the thoracic spine can require extensive tissue dissection, bony disruption, and instability that may warrant the need for instrumentation and fusion. Furthermore, anterior approaches may require the involvement of various surgeons from multiple disciplines to ensure a successful operation and mitigate complications. Currently, available minimally invasive approaches still require bony removal and usually rely heavily on computed tomography (CT)-guided imaging without direct gross visualization. Endoscopic spinal procedures have provided an ultra-minimally invasive alternative to access many areas in and around the spinal column. METHODS We present a 12-year-old boy with a right-sided 2.0 × 3.2-cm paravertebral lesion at the level of T5. The patient successfully underwent an endoscopic approach to the lesion with minimal tissue and bony disruption for tissue diagnosis and tumor resection. RESULTS At initial and 6-month follow-up, the patient remained asymptomatic and without issues. CONCLUSIONS We demonstrate here the feasibility and suggest the safety of a posterior ultra-minimally invasive endoscopic spinal approach to obtain a tissue biopsy of an incidentally found ventrolateral paraspinal tumor in the thoracic region in a pediatric patient. This minimal approach can prove to achieve similar results as other approaches that may otherwise necessitate more extensive or transthoracic procedures.
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Affiliation(s)
- Sanjay Konakondla
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jonathan Nakhla
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jimmy Xia
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Sean M Barber
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jared S Fridley
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Adetokunbo A Oyelese
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Ziya L Gokaslan
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | | | | | - Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany
| | - Albert E Telfeian
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
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13
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Moses ZB, Barzilai O, O'Toole JE. Benign Intradural and Paraspinal Nerve Sheath Tumors: Advanced Surgical Techniques. Neurosurg Clin N Am 2020; 31:221-229. [PMID: 32147013 DOI: 10.1016/j.nec.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traditional surgical techniques for benign intradural and paraspinal nerve sheath tumors often consisted of open posterior approaches. However, these were limited by the morbidity of open surgery. In addition, iatrogenic instability is often required for total resection of larger or laterally located tumors, thus necessitating the use of additional hardware for spinal fusion. Advances in surgical techniques and technologies have allowed for a plethora of minimally invasive approaches throughout the cervical, thoracic, and lumbar regions. These approaches and their particular applications for the resection of benign peripheral nerve sheath tumors are described, with special attention to modern surgical strategies.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John E O'Toole
- Department of Neurosurgery, Coleman Foundation Comprehensive Spine Tumor Clinic, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA.
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14
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Sweeney J, Zyck S, Crye M, Galgano M. Novel Single-Staged Posterior Retropleural Approach with Thoracoscopic Guidance for Resection of a Thoracic Dumbbell Schwannoma. Cureus 2020; 12:e6548. [PMID: 32042523 PMCID: PMC6996463 DOI: 10.7759/cureus.6548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dumbbell spinal cord tumors are infrequent pathologic entities. The optimal approach to safe surgical resection is ill-defined and must often be individualized. This is assisted with multiple tumor classification systems. Here, we describe a novel technique used to safely and successfully resect a large thoracic dumbbell schwannoma originating from the left T3 spinal nerve root with extension into the posterior mediastinum adjacent to the parietal pleura and thoracic aorta. A review of the literature was performed to study described surgical approaches to primary spinal dumbbell tumors. The decision-making process and preoperative imaging for operative planning are included. A detailed description of the procedure follows with intraoperative images. Gross total resection with no neurologic sequelae was achieved. Previously described operative techniques for resection of primary spinal dumbbell tumors with advantages and limitations of each are then reviewed. Gross total resection was safely achieved utilizing a single-staged posterior retropleural approach with anterior thoracoscopic guidance. The tumor was removed en bloc through a large posterior window. The prone position was utilized for the entire case with no intraoperative repositioning required. No intraoperative or immediate postoperative complications occurred. We report a novel approach to resecting a large primary spinal dumbbell tumor. A single-stage retropleural approach with anterior thoracoscopic guidance facilitated safe and successful gross total resection. Maintenance of the prone position throughout surgery allowed for reduced operative time, excellent anterior, and posterior visualization and no added patient morbidity. Repositioning to the lateral decubitus position may not be required in select cases.
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Affiliation(s)
- Jared Sweeney
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Stephanie Zyck
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Mark Crye
- Thoracic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Michael Galgano
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
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15
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Abstract
BACKGROUND Open approaches to the thoracolumbar spine for en bloc vertebral body tumor resection are associated with significant surgical morbidity. Less invasive surgical techniques may reduce complications. OBJECTIVE To present our experience with a staged posterior midline and mini-open anterolateral extracoelomic approach to en bloc corpectomy for vertebral body tumor resection in cadaver specimens and patients. MATERIALS AND METHODS The feasibility and safety of the staged posterior midline and mini-open anterolateral extracoelomic approach were evaluated in 3 cadaveric specimens. The procedure was performed at 3 levels (L1-L3) in each cadaver specimen (9 levels) and then in 1 clinical case. The cadaveric neurovascular structures were evaluated for tissue injury, whereas the operative experience, patient complications, and early surgical and clinical outcomes were reviewed. RESULTS The approach allowed for en bloc corpectomy without any injury to the cadaveric neurovascular structures. The procedure was reproducible in the clinical setting, which showed favorable clinical and radiographic patient outcomes. CONCLUSIONS Early clinical experience suggests the staged posterior midline and mini-open anterolateral extracoelomic approach is feasible and safe for en bloc tumor resection compared with open techniques with related morbidity. Long-term studies are needed to understand the strengths and limitations of this technique.
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16
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Tessitore E, Schonauer C. Commentary: Minimally Invasive Single-Stage Removal of a Thoracic Dumbbell Tumor From a Posterior Approach. Oper Neurosurg (Hagerstown) 2019; 16:E142-E143. [DOI: 10.1093/ons/opy285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
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17
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Phan K, Vig KS, Ho YT, Hussain AK, Di Capua J, Kim JS, White SJW, Lee NJ, Kothari P, Cho SK. Age Is a Risk Factor for Postoperative Complications Following Excisional Laminectomy for Intradural Extramedullary Spinal Tumors. Global Spine J 2019; 9:126-132. [PMID: 30984489 PMCID: PMC6448195 DOI: 10.1177/2192568218754512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The incidence of intradural extramedullary (IDEM) spinal tumors is increasing. Excisional laminectomy for removal and decompression is the standard of care, but complications associated with patient age are unreported in the literature. Our objective is to identify if age is a risk factor for postoperative complications after excisional laminectomy of IDEM spinal tumors. METHODS A retrospective analysis was performed on the 2011 to 2014 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database for patients undergoing excisional laminectomy of IDEM spinal tumors. Age groups were determined by interquartile analysis. Chi-squared tests, t tests, and multivariate logistic regression models were employed to identify independent risk factors. Institutional review board approval was not needed. RESULTS A total of 1368 patients met the inclusion criteria for the study. Group 1 (age ≤ 44) contained 372 patients, group 2 (age 45-54) contained 314 patients, group 3 (age 55-66) contained 364 patients, and group 4 (age > 66) contained 318 patients. The univariate analysis showed that mortality and unplanned readmission were highest among patients in group 4 (1.26%, P = .011, and 10.00%, P = .039, respectively). Postoperative wound complications were highest among patients in group 1 (2.15%, P = .009), and postoperative venous thromboembolism and cardiac complications were highest among patients in group 3 (4.4%, P = .007, and 1.10%, P = .032, respectively). Multivariate logistic regression revealed that elderly age was an independent risk factor for postoperative venous thromboembolism (group 3 vs group 1; odds ratio = 6.739, confidence interval = 1.522-29.831, P = .012). CONCLUSIONS This analysis revealed that increased age is an independent risk factor for postoperative venous thromboembolism in patients undergoing excisional laminectomy for IDEM spinal tumors.
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Affiliation(s)
- Kevin Phan
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Yam Ting Ho
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | | | - John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Nathan J. Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Kothari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Prieto R, Santander X, Naranjo JM, Marín E, Corbacho C. Giant Dumbbell-Shaped Thoracic Schwannoma in an Elderly Patient Resected Through a Single-Stage Combined Laminectomy and Video-Assisted Thoracoscopy: Surgical Strategy and Technical Nuances. World Neurosurg 2018; 119:155-162. [PMID: 30092472 DOI: 10.1016/j.wneu.2018.07.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dumbbell-shaped schwannomas involving the spinal canal, the intervertebral foramen, and the thoracic cavity are rare lesions. Surgical treatment represents a challenge, and there is no consensus regarding ideal management. Two major surgical routes have been used: combined laminectomy and open thoracotomy or posterolateral extrapleural approach with wide bone removal. This report describes a relatively easy surgical strategy, combined laminectomy and thoracoscopy, which allows safe resection under an adequate view with low risk of spinal instability, pain, or respiratory problems. CASE DESCRIPTION A 74-year-old man presented with rapidly progressing motor impairment caused by a dumbbell-shaped, 65-mm, Eden type III lesion at the T5 level. Magnetic resonance imaging showed an intraspinal-extradural mass extending into the chest cavity and causing severe spinal cord compression. The patient underwent single-stage surgery performed by a neurosurgical and thoracic team. The extradural and foraminal tumor components were first removed through a 1-level laminectomy with foraminotomy and without facetectomy. Subsequently, video-assisted thoracic surgery was performed to approach the anterior paraspinal component. Total tumor removal, confirmed with postoperative magnetic resonance imaging, was achieved. Pathologic diagnosis was schwannoma. The postoperative course was uneventful. The patient's neurologic deficits resolved, and he experienced minimal pain after the operation. CONCLUSIONS A single-stage operation using combined laminectomy and video-assisted thoracic surgery is a safe and efficacious strategy for achieving total removal of dumbbell-shaped thoracic schwannomas, even in cases involving giant lesions and elderly patients.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain.
| | - Xavier Santander
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - José Manuel Naranjo
- Department of Thoracic Surgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Esperanza Marín
- Department of Neurophysiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Cesáreo Corbacho
- Department of Pathology, Puerta de Hierro University Hospital, Madrid, Spain
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Phan K, Cheung ZB, Vig KS, Hussain AK, Lima MC, Kim JS, Di Capua J, Cho SK. Age Stratification of 30-Day Postoperative Outcomes Following Excisional Laminectomy for Extradural Cervical and Thoracic Tumors. Global Spine J 2018; 8:490-497. [PMID: 30258755 PMCID: PMC6149039 DOI: 10.1177/2192568217745824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate age as an independent predictive factor for perioperative morbidity and mortality in patients undergoing surgical decompression for metastatic cervical and thoracic spinal tumors using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2014. METHODS We identified 1673 adult patients undergoing excisional laminectomy of cervical and thoracic extradural tumors. Patients were stratified into quartiles based on age, with Q1 including patients aged 18 to 49 years, Q2 including patients aged 50 to 60 years, Q3 including patients aged 61 to 69 years, and Q4 including patients ≥70 years. Univariate and multivariate regression analyses were performed to examine the association between age and 30-day perioperative morbidity and mortality. RESULTS Age was an independent risk factor for 30-day venous thromboembolism (VTE) and reoperation. Patients in Q3 for age had nearly a 4 times increased risk of VTE than patients in Q1 (odds ratio [OR] 3.97; 95% CI 1.91-8.25; P < .001). However, there was no significant difference in VTE between patients in Q4 and Q1 (P = .069). Patients in Q2 (OR 1.99; 95% CI 1.06-3.74; P = .032) and Q4 (OR 2.18; 95% CI 1.06-4.52; P = .036) for age had a 2 times increased risk of reoperation compared with patients in Q1. CONCLUSIONS Age was an independent predictive factor for perioperative VTE and reoperation, but there was no clear age-dependent relationship between increasing age and the risk of these perioperative complications.
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Affiliation(s)
- Kevin Phan
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
- University of New South Wales (UNSW), Sydney, New South Wales,
Australia
| | - Zoe B. Cheung
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khushdeep S. Vig
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mauricio C. Lima
- Spine Group of the Department of Orthopedics of University of Campinas
(UNICAMP), Campinas, São Paulo, Brazil
- Scoliosis Group of AACD (Associação de Assistência à Criança Deficiente),
São Paulo, Brazil
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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