Clinical Effect of Laminectomy with Lateral Mass Screw Fixation in Treating Cervical Schwannoma: A Retrospective Study

Abstract

Background. The objective of this study was to evaluate the clinical effectiveness and safety of laminectomy combined with lateral mass screw fixation in treating cervical intradural extramedullary schwannoma. Methods. We retrospectively collected and analyzed medical records of 38 patients who underwent resection of cervical intraspinal schwannoma between January 2012 and April 2019. Based on different surgical procedures, two groups were divided among all participants: laminectomy-only ( n = 21 ) and laminectomy with instrumented fixation ( n = 17 ); the minimum follow-up time was 1 year. The visual analogue scale (VAS) score and neck disability index (NDI) were utilized for pain assessment; the Japanese Orthopedic Association (JOA) score was carried out for the assessment of neurological impairment. Radiographic changes of Cobb angle were compared before and after the surgery. Results. Consequently, demographics were well matched in both groups, without any statistical difference ( P > 0.05 ). Compared with preoperation, both surgical procedures significantly improved VAS, NDI, and JOA scores ( P < 0.001 ), but no differences between them ( P > 0.05 ). In terms of postoperative spinal instability/deformity, laminectomy-only caused more events than instrumented fixation, which is statistically significant ( P < 0.001 ). Conclusions. In summary, laminectomy with lateral mass screw fixation is an effective and safe approach to treat cervical intraspinal schwannoma, which is likely to be a better choice than the laminectomy-only approach.

Review of Cervical Schwannomas: Presentation, Pathogenesis, Management, Complications and Future Directions

“…In fact, Jinnai, et al, had 100% GTR for all C1-C2 lesions [27]. Nonetheless, surgical resection is associated with significant improvements in patient-reported outcomes and satisfaction [33,34].…”

“…There are several studies that investigate the role of arthrodesis in cervical schwannomas. Laminectomy combined with lateral mass screw fixation is associated with less subsequent spinal instability and deformity compared to laminectomy alone [34]. Furthermore, Sebai, et al, found that total facetectomy was associated with a greater odds of the addition of arthrodesis compared to subtotal facetectomy, likely due to concern about spinal instability [47].…”

“…Another possible complication of spinal surgery is CSF leak. CSF leak following spinal durotomy appears to occur in about 5% of cases and appears to be associated with prior surgery at the index level and cervical vs thoracic location, but does not appear to depend on dural closure technique or other covariates [24,34,48,49,50]. CSF leak is associated with serious infections including meningitis and healing disorders with subsequent repeat surgery [50].…”

A Novel Semi‐Cannulated Screw Enhanced Bone Cement Augmentation and Pullout Strength in Posterior Cervical Lateral Mass Screw Fixations: An In Vitro Biomechanical and Morphological Study

“…8 The thin lamina and anatomical variability in the C3-C6 segments limit the application of translaminar screw fixation techniques. 9 Conversion to a pedicle screw and revision attempt of the fixation trajectory increased neurovascular injury risk because the small and narrow pedicles are surrounded by vital anatomical structures, such as the central spinal cord, nerve roots, and anterolateral vertebral artery. 10 Several research recommends using polymethylmethacrylate (PMMA) to strengthen the bone-implant interface in the osteoporotic spine and as salvage options for thoracolumbar pedicle screw loosening.…”

“…A different approach and change in surgical position are required for anterior fixation, and potential morbidities such as nerve root injuries may occur 8 . The thin lamina and anatomical variability in the C3–C6 segments limit the application of translaminar screw fixation techniques 9 . Conversion to a pedicle screw and revision attempt of the fixation trajectory increased neurovascular injury risk because the small and narrow pedicles are surrounded by vital anatomical structures, such as the central spinal cord, nerve roots, and anterolateral vertebral artery 10 …”