Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution

Unilateral Hemilaminectomy as Primary Treatment for Spinal Cord Tumors: Retrospective Cohort of 38 Cases with a Minimum Follow-Up of 24 Months

OBJECTIVE

To evaluate the efficacy of hemilaminectomy as an approach to intradural tumors and to assess the risk of postoperative spinal instability.

METHODS

This is a retrospective cohort study of 38 patients who underwent surgical resection of intradural tumors between November 2014 and March 2019. Clinical and radiologic data were documented in medical records, from which we obtained clinical data including age, gender, tumor etiology, lesion level, type of resection, and postoperative instability during follow-up.

RESULTS

Schwannomas and meningiomas were the most commonly treated tumors. The lesion locations were as follows: 8 cervical (21%), 19 thoracic (50%), 10 lumbar (26%), and 1 sacral (3%). The mean follow-up time was 28 months. In all cases, hemilaminectomy allowed for the removal of the tumors without clinical or radiologic evidence of postoperative mechanical instability. Hemilaminectomy was primarily performed on 2 segments but was extended to up to 6 levels in some cases.

CONCLUSIONS

Unilateral hemilaminectomy is an effective technique that facilitates complete tumor removal with a low rate of postoperative instability in the operated segments.

Posterior paramedian approach combined with a novel inverted V-shaped surgical access for intraspinal schwannomas: a retrospective case series study

OBJECTIVE

To explore the efficacy and safety of the posterior paramedian approach combined with a novel inverted V-shaped surgical access for the treatment of intraspinal schwannomas.

METHODS

This study retrospectively reviewed consecutive patients who underwent surgical resection of the intraspinal schwannomas via the inverted V-shaped approach at our center between January 2016 and May 2021. Changes between the preoperative and postoperative visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Secondary outcomes such as success rate of tumor resection, operation time, blood loss, spinal stability, and disruption degree of intervertebral joints. Postoperative complications were also investigated.

RESULTS

Of these 36 consecutive patients, there were 6 cases in the cervical spine, 2 cases at the cervical-thoracic junction, 11 cases in the thoracic spine, 4 cases at the thoracic-lumbar junction and 13 cases in the lumbar spine. The average operation time was 99 min, and the average blood loss was 95.4 mL. The tumor removal rate was 100%. Postoperative CT re-examination showed that the spinous processes were intact in all cases, the facet joint surfaces were intact in 32 cases. At the time of last follow-up, the median JOA score was 25 (9-27), which was significantly improved compared to the preoperative median JOA score of 15 (10-22) (P < 0.01). The overall excellent and good rate were 88.9 %. The median VAS score at post-surgery was 0 (0-2), which was significantly improved compared to the preoperative median VAS score of 4 (2-8) (P < 0.01). As for complications, there were no cases of cerebrospinal fluid leakage or spinal instability. Three patients who had a postoperative fever finally recovered after lumbar cistern drainage.

CONCLUSION

The inverted V-shaped surgical access via the posterior paramedian approach is an effective and safe method for the treatment of intraspinal schwannomas.

Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors

Minimally invasive spinal surgery (MISS) for intradural extramedullary (IDEM) spinal tumors is a safe and effective surgical strategy. Currently, various tubular retractors are widely used in the MISS of IDEM spinal tumors, primarily relying on microscopic visualization. To the best of the authors' knowledge, there is no report of pure endoscopic surgery with parallel non-expandable tubular retractors for IDEM spinal lesions. The present study reports a case series of IDEM spinal tumors that were treated via pure endoscopic MISS with a parallel non-expandable tubular retractor. The extent of tumor resection was evaluated by comparing preoperative and postoperative magnetic resonance imaging (MRI). The initial and follow-up clinical conditions were assessed according to the visual analog scale for pain and the modified McCormick scale for neurological status. Postoperative MRI demonstrated that all cases had achieved a gross total resection. After the operation, the clinical symptoms of all patients were significantly improved and there were no serious postoperative complications. At the initial follow-up, the pain experienced by the patients was significantly reduced or had even disappeared, and the neurological deficit was improved by at least one grade on the modified McCormick scale. The present report indicates that pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.

Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients

Objective

We report our experience with the use of hemilaminectomy approach for the removal of benign intraspinal tumors.

Method

A retrospective review of 1,067 patients who underwent hemilaminectomy in our hospital between 2013 and 2019 was analyzed. Baseline medical data were collected. One hundred sixteen patients were excluded due to degenerative diseases, spinal bone tumors, and malignant tumors. The remaining 901 patients (916 tumors) were enrolled. The Dennis Pain Scale (DPS) was used to assess improvement in pain before surgery and during long-term follow-up. Neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale.

Results

The age of the patients was 48.7 ± 15.3 years, the duration of symptoms was 16.5 ± 32.0 months, and the tumor size was 2.6 ± 1.4 cm. Three hundred two tumors were located in the cervical region, 42 in the cervicothoracic region, 234 in the thoracic region, 57 in the thoracolumbar region, and 281 in the lumbar and lumbosacral region. Twenty-three tumors were ventrally located, 677 were dorsal or dorsolateral, 63 were intramedullary, 87 were epidural, and the rest were dumbbell-shaped. The most common pathologies were schwannomas (601, 66.7%) and meningiomas (172, 19.1%). Total excision was achieved at 97.8%. The operative time was 94.3 ± 32.6 min and the blood loss during surgery was 96.9 ± 116.5 ml. The symptom of pain improved in 87.0% of patients during long-term follow-up, neurological function improved in 68.3% and remained unchanged at 30.5%.

Conclusion

The hemilaminectomy approach was a rapid and safe procedure to remove intradural and extradural tumors. This approach has offered several advantages. It could be used for the resection of most extradural or intradural extramedullary lesions, even some intramedullary tumors.

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis

Osbjective

Several studies have shown that both microscopic unilateral laminotomy bilateral decompression (ULBD) and unilateral biportal endoscopic (UBE) ULBD are effective for treating lumbar canal stenosis (LCS). However, there are different viewpoints as to which surgical technique is superior. Therefore, this meta-analysis investigated the clinical efficacy and side effects of microscopic ULBD and UBE ULBD for treating LCS.

Methods

To identify relevant studies describing the clinical outcomes and complication rates of microscopic ULBD and UBE ULBD for LCS, several databases were systematically searched in the Internet. The visual analog scale score for back and leg pain and the Oswestry Disability Index were used to assess clinical outcomes. Furthermore, data about perioperative outcomes and complications were documented.

Results

In total, six studies with 450 participants were included in this meta-analysis. The UBE ULBD was found to be superior to microscopic ULBD in terms of efficacy against early postoperative back and leg pain. However, there was no significant difference between the two procedures in terms of final clinical outcomes and complications. In addition, compared with microscopic ULBD, UBE ULBD was associated with a significant reduction in the length of hospital stay and C-reactive protein levels 2 days after surgery.

Conclusion

UBE ULBD and microscopic ULBD for the treatment of LCS were similar in terms of final clinical outcomes and complications. However, UBE ULBD has several advantages over microscopic ULBE, including a shorter hospital stay and faster alleviation of postoperative back and leg pain.