Comparison of microscopic full-laminectomy (open surgery) and microendoscopic minimally invasive hemilaminectomy for thoracic extramedullary spinal tumours

BACKGROUND

Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery).

METHODS

Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed.

RESULTS

In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393).

CONCLUSIONS

MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.

Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: A systematic review and meta-analysis

OBJECTIVE

Lumbar synovial cysts (LSC) are one of the manifestations of spinal degenerative cascade. Spinal stenosis or presence of instability in these patients can lead to various symptoms and surgery is indicated following failure of non-operative management for symptomatic synovial cysts. Surgery when performed consists of either decompression with resection of cyst with our without fusion. The efficacy and complications of minimally invasive techniques using tubular retractors (microscopic or endoscopic) in comparison to traditional open techniques remain to be studied.

METHODS

A comprehensive search of different databases was performed to retrieve studies describing the use of minimal invasive techniques using tubular retractors (both microscopic and endoscopic) in patients with LSC. Meta-analysis with subgroup analysis and metaregression was done.

RESULTS

Twenty articles were selected for the systematic review and meta-analysis with total of 388 patients. Eighty-six percent of patients (95% Confidence Interval (CI): 80-90%) had favorable outcome as per Macnab's criteria (excellent and good outcome) with the pooled standard mean difference between preoperative and postoperative Oswestry Disability Index (ODI) being -4.44 (95% CI -8.78 to -0.10, p-value=0.0474, I² 82%). The pooled percentage change in visual analogue scale (VAS) after surgery was 76.5% (95% CI 66.9-84%, I² 82%). The pooled proportion of incidental durotomies, cyst recurrence and patients requiring operation being 8% (95% CI 5-11%, I² 0%), 4% (95% CI 2-7%, I² 0%,) and 5% (95% CI 3-9%) respectively. Studies were homogeneous with an I² value of 0%. Subgroup analysis revealed no significant difference in the outcome rates or complication rates between the microscopic and endoscopic subgroups.

CONCLUSION

Minimally invasive techniques for the resection of LSC is a safe and effective alternative to traditional surgical approaches with no difference between the microscopic and endoscopic approaches.

Abordaje mínimamente invasivo para el tratamiento de tumores espinales intradurales extramedulares: Nota Técnica

Objetivo:

Describir la técnica de abordaje mínimamente invasiva para el tratamiento de tumores intradurales extramedulares en los diferentes segmentos espinales.

Material y Métodos:

Se detallan la planificación, posicionamiento, marcación, pasos técnicos del abordaje mínimamente invasivo, exéresis lesional y cierre de lesiones ID-EM a nivel cervical, dorsal, lumbar y sacro. Se proporcionan recomendaciones para descomplejizar maniobras quirúrgicas, acortar el tiempo operativo y evitar potenciales complicaciones.

Conclusiones:

El abordaje MISS es una opción segura y eficaz para el tratamiento quirúrgico de determinados tumores ID-EM.