A Control Study On The Clinical Effects Of Treatment For Intracmedullary Extramedullary Tumor By Different Operation Methods Based On 400 Cases

Objective To compare the clinical effect and operative complications of common surgery in the treatment of intraspinal extramedullary tumors,and to summarize the advantages,disadvantages and indications of different surgery.Meanwhile,the epidemiological characteristics and MRI diagnostic value of extramedullary tumors were summarized to improve the accuracy of early diagnosis.Methods The clinical data of 400 patients with intraspinal extramedullary tumors who were treated in the First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2019 were analyzed retrospectively.The distribution characteristics of lateral and longitudinal localization diagnosis and qualitative diagnosis of extramedullary tumors were counted and compared with those of MRI diagnosis.There were 5 types of operation methods for the treatment of extramedullary tumors in our hospital.Among them,type A(total laminectomy+ screw-rod internal fixation + tumor resection)and type B(semi-laminectomy +screw-rod internal fixation + tumor resection)were performed by Spinal Surgery;type C(total laminectomy + tumor microscopic excision),type D(semilaminectomy + tumor microscopic excision),type E(laminoplasty + tumor microscopic excision)were completed by Neurosurgery.The clinical effects,complications and direct medical costs of above 5 types of operation methods in cervical,thoracic,lumbar and sacral segments were evaluated.The clinical efficacy included intraoperative blood loss,total tumor resection rate,operation time,time out of bed,hospital stay,Numeric Rating Scales(NRS)and Japanese Orthopaedic Association(JOA)score.Complications included massive intraoperative hemorrhage,nerve tissue injury,cerebrospinal fluid(CSF)leakage,incision complications,intraspinal infection,lung and urinary tract infection,tumor recurrence,spinal instability and deformity.Results(1)The accuracy of MRI lateral localization diagnoses of intraspinal extramedullary tumors was 90.0%,and the accuracy of qualitative diagnosis was72.3%.It was easy to mistakenly judge other pathological types of tumors including hemangioma as schwannomas.(2)There was no significant difference in intraoperative blood loss,total tumor excision rate,nerve tissue injury,CSF leak,wound complications and tumor recurrence among those 5 types of operation methods(P >0.05).While in terms of operation time,time out of bed,hospital stay,intraspinal infection,lung and urinary tract infection,type A and B had significant advantages over type C,D and E(P >0.05).The postoperative pain NRS scores of the 5 types methods after the operation were significantly lower than those before operation(P <0.05),and the postoperative cervical JOA-C,thoracic JOA-T and lumbar JOA-B score were significantly higher than those before operation(P <0.05),but there was no significant difference in the improvement rate of JOA score among the 5 operation methods(P >0.05).No significant difference was found in the spinal stability of one segment between the 5 types of operation methods(P=0.280).In the comparison of two segments and above,the rate of spinal instability after type C operation was the highest,and the pairwise comparison suggested that the rate of spinal instability was higher than that of operation A(P=0.002).(3)The comparison of direct medical costs among the 5 types of operations showed that there were differences between groups.Among them,the operation cost of type A and B was higher than that of type C,D and E,but the non-operation cost was lower(P <0.05).The pairwise comparison of total cost showed that only the C and D surgical procedures have significant advantages over the A and E surgical procedures respectively(P <0.05).Conclusion(1)The application of common clinical procedures in Spinal Surgery and Neurosurgery can safely and effectively remove extramedullary tumors and obtain satisfactory recovery of neurological function.In addition,the postoperative rehabilitation management of Spinal Surgery was more efficient and the incidence of intraspinal infection was lower,which can effectively reduce non-surgical costs.(2)Before operation,the operation should be individualized according to the location and size of the tumor,and if necessary,it can be decided whether to perform spinal internal fixation and bone graft fusion at the same time according to the situation of removing the posterior column structure during the operation.