Novel combination of paraspinal keyhole surgery with a tubular retractor system leads to significant improvements in lumbar intraspinal extramedullary schwannomas

Abstract

The aim of the present study was to investigate the efficacy of combining paraspinal keyhole surgery with a tubular retractor system for the microsurgical removal of lumbar intraspinal extramedullary schwannomas. A retrospective analysis was conducted of 56 patients with lumbar intraspinal extramedullary schwannomas who were treated using the microsurgical paraspinal keyhole approach with a tubular retractor system. The mean ± standard deviation was calculated for the following parameters: Surgery time (96.21±14.64 min), hemorrhagic volume (28.54±9.72 ml), bed rest (2.55±0.5 days) and hospital stay (5.68±0.72 days). Two patients presented with cerebrospinal fluid leakage and one patient exhibited a nerve root injury. At a 6-month follow-up visit, postoperative Japanese Orthopedic Association (JOA) and visual analog scale (VAS) scores were evaluated. The mean ± standard deviation JOA scores were 12.00±2.07 for preoperative, 14.73±2.05 for 1 week postoperative, 20.07±2.32 for 3 months postoperative and 21.75±2.18 for 6 months postoperative. The improvement rate was 16.07, 47.48 and 59.77%, respectively. The mean ± standard deviation VAS scores were 6.64±1.31 for preoperative, 3.82±1.51 for 1 week postoperative, 2.11±1.17 for 3 months postoperative and 1.50±1.51 for 6 months postoperative. The JOA and VAS scores improved significantly (P<0.05). Magnetic resonance imaging and computed tomography were performed preoperatively, immediately following surgery and at the 6-month postoperative visit to confirm the efficacy of the resections and evaluate spinal stability. No residual tumors were identified at follow-up. No alterations in the stability of the spine were observed postoperatively. The combination of the microsurgical paraspinal keyhole approach with the tubular retractor system was successful in treating lumbar intraspinal extramedullary schwannomas. The surgical approach was associated with decreased hemorrhages, decreased duration of hospital stay, faster recovery and improved postoperative maintenance of spinal stability.

Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial

“…Since then, the results of multiple randomised controlled trials (RCTs) and systematic reviews12–15 comparing the efficacy of tubular microdiscectomy (TMD) and CMD have revealed no significant difference between the two. Recently, Zhuang et al and Chunmei et al 16 17 improved on the tubular retractors and trocar systems and introduced the paraspinal minitubular microdiscectomy system (PMTM). PMTM is characterised by a smaller tubular diameter which can achieve bilateral decompression based on the surgical approach from one side.…”

Comparison of the Clinical Efficacy of Transforaminal Endoscopy and Microtubular Technology for the Treatment of Lumbar Dumbbell-Shaped Tumors

“…We have previously performed intraspinal subdural schwannoma and thoracic dumbbell tumor resections using the microtubular technique, and we have also attempted lumbar dumbbell tumor resection under spinal endoscopy. 9,15,16 For Eden type III-IV lumbar tumors with a single segment and a maximum diameter of < 5 cm, both PTET and PAMT achieved 1-stage total resection. In PTET approach, the tumor resection procedure extends from the paravertebral tumor to the intraspinal canal tumor.…”

Minimally Invasive Tubular Retractor Surgery for Intradural Extramedullary Spinal Tumor Reduces Postoperative Degeneration of Paraspinal Muscle

“… 24 Zhuang et al further concluded that the MIS surgery with tubular retractor allowed more functional improvement and pain reduction at postoperative 6 months. 25 En bloc resection of the intradural extramedullary spinal tumor with its dural attachment theoretically achieves the best oncological outcome. However, a hard tumor consistency, ventral site of dural attachment, and poor arachnoid plane often limit en bloc resection.…”