Limited unilateral approach for extramedullary spinal tumours

Abstract

Traditionally, spinal extramedullary tumours are approached by a wide multilevel laminectomy and a midline dural incision. This exposure may result in immediate or delayed instability of the spine, and exposes the spinal cord to the possibility of inadvertent injury during surgery. To avoid these complications the authors have, in 27 patients, used a limited unilateral approach to remove extramedullary tumours. The approach entails bone removal which is limited to the lateral half of the lamina on the side of the tumour and may or may not include the medial part of the facet joint. A lateral dural flap exposes the tumour without exposing the cord. Extraspinal extensions of the lesion may be approached by extending the laminectomy further laterally to the facet joint. This technique has been used in the cervical, thoracic and the lumbar spine to radically remove the lesion in all cases. There were no complications. The authors conclude that extramedullary lesions of the spine can be removed radically by this approach which allows direct access without cord or root retraction, and with little disturbance to the normal anatomy.

Minimally invasive approach for the treatment of intradural spinal pathology

“…Twenty-five patients were ambulating within 24 hours of surgery and 48% of patients were discharged to home by postoperative Day 2. In our anecdotal experience and in other series, 10 patients undergoing an open excision are often kept on bed rest for 24-72 hours, thus increasing the risk of pressure ulcers and deep vein thrombosis. Although our average blood loss of 197 ml (range 15-900 ml) is higher than other series, 4,6 only 1 patient in our series required transfusion.…”

“…This approach has been associated with fewer complications, better outcomes, and shorter hospital stays. 2,7,10,13,14 In our series, only 1 patient underwent fusion at the time of surgery (Case 3) because the entire facet was removed to reach the tumor. One patient required anterior cervical discectomy and fusion for degenerative disc disease, but this was to treat a preexisting condition.…”

Surgical Strategies in the Management of Spinal Nerve Sheath Tumors

“…Most SNSTs are easily accessible with standard operative approaches and carry a good prognosis. Lesions with large extraspinal extension, ventral tumors, and giant lesions with extensive bony scalloping may require wider or circumferential surgical approaches, spinal stabilization, and multidisciplinary involvement (3,12,16,32,37,45,47,50).…”

The Long-term Clinical Effect of Minimal-Invasive TLIF Technique in 1-Segment Lumbar Disease

“…This approach carries the benefits of reducing approach-related morbidity, which in turn leads to excellent clinical results such as lower incidence of low back pain (LBP), shorter hospital time, and reduced blood loss. 5,6 The advantages of the technique in reducing both hospital time and blood loss have been reported in previous serial studies. 5,7 However, no longterm prospective cohort study evaluating its comprehensive clinical effect has been carried out to date.…”

“…5,6 The advantages of the technique in reducing both hospital time and blood loss have been reported in previous serial studies. 5,7 However, no longterm prospective cohort study evaluating its comprehensive clinical effect has been carried out to date. The purpose of this study was to compare miTLIF with oT-LIF to analyze its clinical effects in dealing with 1-segment lumbar disease and also to analyze the possible reasons for the difference.…”