Laminectomy versus Unilateral Hemilaminectomy for the Removal of Intraspinal Schwannoma: Experience of a Single Institution and Review of Literature

Abstract

Background and Study Aims Spinal schwannomas are benign slow-growing tumors, and gross total resection is the gold standard of treatment. The conventional surgical approach is laminectomy, which provides a wide working area. Today minimally invasive surgery (MIS) is popular because it is associated with shorter hospital stay, less operative blood loss, minimized tissue traumas and relative postoperative pain, and, and spine surgery, avoidance of spinal instability. Material and Methods From January 2016 to December 2019, we operated on 40 patients with spinal intradural extramedullary tumor (schwannoma) with laminectomy or hemilaminectomy. Baseline medical data, including patients' sex and age, tumor location, days of postoperative bed rest, operative time, length of hospitalization, and 1-month visual analog scale (VAS) value were collected and analyzed. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, Texas, United States). Results Hemilaminectomy was associated with faster operative time (p < 0.001), shorter postoperative time spent in bed (p < 0.001), and shorter hospitalization (p < 0.001). At 1-month follow-up, the mean VAS score was 4.6 (1.7) among the laminectomy patients and 2.5 (1.3) among the hemilaminectomy patients (p < 0.001). Postoperative complications occurred in 1 (7.7%) and 7 (25.9%) patients in the hemilaminectomy and laminectomy groups, respectively (p = 0.177). Conclusions Unilateral hemilaminectomy has significant advantages compared with laminectomy in spinal schwannoma surgery including shorter operative time, less time spent in bed, shorter hospitalization, and less postoperative pain.

Factors Related to the Deterioration of Postoperative Lower Back Pain in Hemilaminectomy Approach for Lumbar Spinal Schwannoma Resection

“…22,23 Thus, hemilaminectomy has become one of the preferred surgical approaches for intradural spinal tumors and chronic degenerative diseases. 24,25 Our surgical series on lumbar spinal schwannomas also demonstrated the safety and efficacy of the hemilaminectomy approach. Our study, which is in line with a recently reported series, 24,26 showed a dramatically alleviated lower back pain and improvement in neurological function deficit at…”

“…24,25 Our surgical series on lumbar spinal schwannomas also demonstrated the safety and efficacy of the hemilaminectomy approach. Our study, which is in line with a recently reported series, 24,26 showed a dramatically alleviated lower back pain and improvement in neurological function deficit at…”

“…While a large amount of A-train is exhibited on sEMG intraoperatively, the surgeon should stop manipulating the nerve and look for compression or injury to ensure that corrections can be performed before the injury becomes permanent. In this study, we investigated the occurrence of A-train on sEMG in a portion of patients, and further investigation should be performed to explore the detailed information of A-train, such as the total train time and association of train time and lower back pain, while also While most published articles focus on overall morbidity and mortality and postoperative neurological function deficit, 24,37 postoperative pain and related risk factors are often underestimated. The findings of this study identified predictors of adverse lower back pain after lumbar spinal schwannoma resection, which included the length of hemilamina removal and tumor size in the univariate analysis.…”

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

“…Generally, the choice of surgical methods should depend on the location and extent of tumor invasion. The classic surgical approach for intradural schwannomas is the total laminectomy via posterior paramedian approach [ 18 , 19 ]. However, in recent years, this approach has been gradually replaced with the development of minimally invasive techniques.…”

Spinal dermal sinus coinciding with an infected giant epidermoid cyst in an infant presenting with constipation: a case report

“…Recent evidence suggests that unilateral laminectomy is effective in achieving complete resection of spinal tumors along with reducing the threat of postoperative deformity and spinal instability. 33,34 Re-surgery may be required in the presence of a residual tumor or tumor regrowth, and in the case of postoperative spinal instability. The present case has met the definition of a giant tumor.…”