Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

Chotai, Silky; Zuckerman, Scott L.; Parker, Scott L.; Wick, Joseph; Stonko, David P.; Hale, Andrew T.; McGirt, Matthew J.; Cheng, Joseph; Devin, Clinton J.

doi:10.1093/neuros/nyw126

Cited by 19 publications

(23 citation statements)

References 50 publications

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“…There was no worsening in functional status. This is also consistent with the results of other studies that showed a good response and improved quality of life in patient follow-up [6][7][8][9][10] . Riad et al, for example, observed a sensory and / or motor improvement in 87% of the patients and 85% of those who presented gait changes at admission were able to walk autonomously at the end of the follow-up 6 .…”

Section: Discussionsupporting

confidence: 92%

Evaluation of prognostic factors and outcomes following intradural Extramedullary spinal Tumor Resection

Júnior¹,

Cysneiros²,

Aquino³

et al. 2021

jbnc

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Introduction: Intradural extramedullary spinal tumors are usually treated with surgical excision in order to achieve functional improvement and quality of life. Objective: The aim of this study was to identify prognostic factors and to evaluate the outcome of surgical treatment. Methods: Data from medical records of 49 patients who underwent surgery for intradural extramedullary spinal tumor in a single institution - Hospital da Restauração - were collected. The outcome of the patients was assessed through the McCormick Scale and EuroQol-5 dimensions (EQ-5D) in the preoperative period and last follow-up. Results: Significant improvement in the functional status after surgical treatment was observed. There was 93.3% of improvement and 6.7% of stability. A worse functional result was related to a longer symptoms duration (p = 0.074). Age, symptoms duration, tumor location, histopathological diagnosis, and McCormick preoperative had no significant association with the McCormick at final follow-up (p>0.05). Conclusion: Surgical treatment significantly improved the quality of life and neurological deficits of the vast majority of patients. Age, symptoms duration, tumor location, histopathological diagnosis and McCormick preoperative grade did not present prognostic correlation in this study.

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Section: Discussionsupporting

confidence: 92%

Evaluation of prognostic factors and outcomes following intradural Extramedullary spinal Tumor Resection

Júnior¹,

Cysneiros²,

Aquino³

et al. 2021

jbnc

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“…The early recognition of signs and symptoms, that allows diagnosis of early-stage disease before spinal cord damage occurs, can reduce the risk of postoperative morbidity and may improve surgical outcome (29)(30)(31). A strong correlation has been suggested between the degree of functional impairment and the extent of damage to the spinal cord or spinal roots: the greater the impairment, the longer the persistence of the lesion, and the more difficult postoperative functional recovery will be, despite radical tumor removal (32)(33)(34)(35). In this regard, the present study confirmed previous results of the literature.…”

Section: Discussionmentioning

confidence: 99%

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

et al. 2020

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Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

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“…However, the operation fields of these approaches are deep and narrow and require the resection of vital components of the atlantoaxial spine. The prolonged surgical time of the combined anterior-posterior approach has been linked to iatrogenic traumatism[ 4 ]. The posterior approach is the most widely used.…”

Section: Introductionmentioning

confidence: 99%

Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach

Meng¹,

Wang²,

Yang³

et al. 2022

WJCC

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BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary (IDEM) tumors. Studies concerning surgical interventions via a posterior approach are limited. AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach. METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018. The analyzed data included tumor position, histopathological type, pre- and post-operative Japanese Orthopedic Association (JOA) scores and Nurick grades, postoperative complication and recurrence status. RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study. In all cases reviewed, total tumor resection and concomitant C1-C2 fusion were achieved. The average follow-up was 35.3 ± 6.9 mo (range, 26-49 mo). A statistically significant difference was noted between the preoperative JOA score (11.2 ± 1.1) and the score at the last final follow-up (15.6 ± 1.0) ( P < 0.05). A statistically significant difference was noted between the preoperative Nurick grade (2.3 ± 0.9) and that at the last follow-up (1.2 ± 0.4) ( P < 0.05). However, no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle ( P > 0.05). No mortalities, severe complications or tumor recurrence were observed during the follow-up period. CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach. Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.

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Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

Cited by 19 publications

References 50 publications

Evaluation of prognostic factors and outcomes following intradural Extramedullary spinal Tumor Resection

Evaluation of prognostic factors and outcomes following intradural Extramedullary spinal Tumor Resection

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach

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