| Background: Extramedullary subdural tumors are the most common types of intraspinal tumors,among which neurilemmoma and meningioma have the highest incidence rate.Once confirmed clinically,surgical resection is the only effective treatment.Since the1980 s,the approach of tumor resection has undergone total laminectomy,hemilaminectomy,and laminoplasty.Since the principle of surgery is to fully expose and completely resect,and at the same time to maximize the stability of the spine,laminoplasty is commonly used in the clinic.Among them,various types of total laminectomy,replantation,and internal fixation are mostly used.However,this operation has many disadvantages,such as more peeling,more trauma,more damage to the posterior column,slow healing,and a high application cost for internal fixation.Whether there is a more ideal surgical method in clinical practice,which adopts laminoplasty and a minimally invasive concept to minimize the damage of muscle,soft tissue,and bone structure and is conducive to rapid postoperative healing.At the same time,internal fixation is not adopted to maximize the stability of the spine,which needs further study.Objective: To explore the practicability,safety,and effectiveness of the single-door laminoplasty with muscle pedicle for the removal of intramedullary extradural tumors in the spinal canal.Methods: From March 2016 to June 2021,a total of 25 patients with intramedullary extradural tumors in the spinal canal who met the requirements of the study were retrospectively analyzed,including 15 cases of neurilemmoma,10 cases of meningioma,7cases in the lumbar segment,and 18 cases above the lumbar segment.All patients underwent tumor resection through the single-door laminoplasty approach with muscle pedicle.Each patient recorded in detail whether the tumor was completely removed,the operation time,the amount of bleeding,the cerebrospinal fluid leakage,the tumor size,the pathological results,the length of hospitalization,the cost,and other general information.In addition,the VAS score of lumbago and leg pain was recorded before,1 month,and 3 months after the operation for lumbar tumors,the ODI score before,3 months after the operation,and the last follow-up,and the Cobb angle of lumbar lordosis in the standing position before and at the last follow-up were compared respectively;The JOA scores of tumors above the lumbar segment were recorded before operation,3 months after operation and the last follow-up,and the local kyphosis Cobb angle of standing position was compared before operation and the last follow-up.All patients were routinely followed up with a three-dimensional CT within 1 week,3 months,and the last follow-up to observe the healing of the formed vertebral lamina and whether there was obvious displacement and secondary spinal stenosis;An MRI examination was performed within 1 week after the operation and at the last follow-up to observe the soft tissue healing of the posterior ligament.Results: All intraspinal tumors in this group were fully exposed and completely removed,with 3 cases experiencing cerebrospinal fluid leakage.After drainage,the incision was compressed and bandaged,and it all healed without any related complications.The surgical time was 91 ± 18 minutes,the bleeding volume was 104 ± 53 ml,the length of hospitalization was 11 ± 2 days,and the hospitalization cost was 20591.33 ± 3159.81 yuan.Postoperative pathological results confirmed 15 cases of schwannoma and 10 cases of meningioma,with the largest volume being approximately 3.5×2×1 cm,and the smallest one being about 1 × 1 × 1 cm.For those with tumors located in the lumbar region,postoperative symptoms of lower back and leg pain were significantly improved compared to before surgery.The VAS score showed preoperative lower back pain of 5.0 ± 0.8 points,postoperative 1 month of 2.7 ± 0.7 points(Z=-2.460,p=0.014),and postoperative 3 months of 0.9 ± 0.6 points(t=15.884,p<0.001),all of which showed significant improvement compared to before surgery;Preoperative leg pain was 6.1 ± 1.0 points,with an average score of 3.0 points(Z=-2.428,p=0.015)in the first month after surgery,and 1.1 ± 0.9 points(Z=-2.401,p=0.016)in the third month after surgery.The postoperative symptoms were significantly improved compared to before surgery.The preoperative ODI score was 79.7 ±8.5%,with an average of 40.0% at 3 months after surgery(t=12.840,p<0.001),and an average of 12.0% at the last follow-up(t=23.431,p<0.001).The postoperative outcomes were significantly improved compared to before surgery.The Cobb angle of lumbar lordosis in preoperative standing position was 49.4 ° ± 10.2 °,and the last follow-up was 49.7 ° ±10.8°.There was no significant difference before and after surgery(t=-0.282,p=0.788).For patients with tumors located above the lumbar spine,the JOA score was 11.8 ± 2.4 points before surgery,13.9 ± 1.6 points at 3 months after surgery(Z=-3.772,p<0.001),and the average follow-up score was 16.0 points(t=8.464,p<0.001).The postoperative outcomes were significantly improved compared to before surgery.The average Cobb angle of local kyphosis in preoperative standing position was 10.7°,and the average follow-up angle was10.6°.There was no significant difference before and after surgery(t=-1.485,p=0.156).All patients were followed up for more than 12 months,and their symptoms significantly improved or even recovered.Around 3 months after surgery,a three-dimensional CT scan was performed.Partial callus formation or even complete healing was observed on the axial side of the vertebral lamina(with muscle pedicle),and by the last follow-up,the majority reached bone fusion.Different degrees of broken-end sclerosis or healing were observed on the open side,and no signs of broken-end necrosis,absorption,significant displacement,or secondary spinal stenosis were observed on all vertebral lamina.During the last follow-up MRI scan,no tumor recurrence or other abnormalities were found,and all soft tissues such as the posterior ligaments and muscles healed well.During the follow-up period,all patients did not experience spinal instability or deformities.Conclusion: Through the single-door laminoplasty approach with muscle pedicle,the effect of resection of intramedullary extradural tumors in the spinal canal is accurate.On the premise of ensuring that the tumor is fully exposed and completely removed,the muscle ligaments and bone tissue structure are preserved to the greatest extent,with little impact on the stability of the spine.The postoperative incision healing is fast and the pain is light,which significantly accelerates the healing of the vertebral lamina.At the same time,internal fixation is not required,which reduces the cost and reduces the relevant risks,It is conducive to rapid recovery after the operation. |
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