To Compare Surgical Methods And Efficacies For Cervicothoracolumbar Sacrum Spinal Schwannoma

Objective:The aim of this study was to investigate the surgical methods and efficacies for the cervical thoracic lumbar sacral vertebral schwannoma. And to investigate the surgical methods of schwannoma cerebrospinal fluid leakage after operation.Clinical efficacies of spinal sagittal balance of cervical thoracic lumbar sacral vertebral schwannoma before operation was observed. Methods: A total of 55 patients who had undergone treatment for schwannoma were retrospectively analyzed in our hospital from 2010.1 to 2015.1.28 cases of male, 27 cases of female. The cervical schwannoma 5 cases, thoracic schwannoma 23 cases, lumbar schwannoma 25 cases, sacral schwannoma 2 cases. 1) Two methods were employed for the surgical resection of the thoracic and lumbar sacral schwannomas in 50 cases; Group I(posterior midline approach semi-laminectomy with tumor resection and internal fixation with pedicle screws)was used in 24 cases, and Group II(posterior midline approach laminectomy with tumor resection and internal fixation with pedicle screws)was used in 26 cases. 2 cases of giant cervical schwannoma were treated via anterior-posterior combined surgery, 3 cases of cervical schwannoma were treated by posterior approach. Histopathological examination confirmed the diagnosis of schwannoma in all cases(n=55). The clinical status of the patients was evaluated pre-and postoperatively using the visual analog scale, Oswestry Disability Index and Japanese Orthopedic Association scale, Frankel classification, and the scores associated with the two types of surgical method were compared. 2) 24 cases of postoperative cerebrospinal fluid leakage, 12 patients were treated with lumbar subarachnoid catheter(a catheter group), 12 cases with wound continuous drainage treatment group(drainage group). Comparison of cerebrospinal fluid leakage stop time between two group. 3)55 patients were evaluated by Japanese Orthopaedic Association(JOA) and visual analog scale(VAS) scores for low-back pain, leg pain, and leg numbness before and after surgery. The distance between the C-7 plumb line and the posterior corner of the sacrum(sagittal vertical axis [SVA]) was measured on lateral standing radiographs of the entire spine obtained before surgery. Radiological factors and clinical outcomes were compared between patients with a preoperative SVA ≥ 50mm(forward-bending trunk[A]group)and patients with a preoperative SVA<50mm(control[B]group). A total of 11 patients were allocated to the A group and 44 to the B group, They examined correlations between preoperative or postoperative sagittal vertical axis(SVA) and PI,SS,PT,LL,Cobb, clinical outcomes in patients divided according to SVA. Clinical outcomes were assessed according to JOA and VAS scores. Follow-up of 6 months to 3 years. Results: 1) two surgical procedure of postoperative VAS score, ODI score, JOA score, Frankel classification are obviously improved. 2) Postoperative cerebrospinal fluid leakage catheter group compared with drainage group, catheter group of cerebrospinal fluid leakage stop time significantly shortened(P<0.05). In catheter group, 1 case of cerebrospinal fluid infection happened and in 2 cases treated with drainage of cerebrospinal fluid cyst cases were cured after symptomatic treatment. No recurrence cases were found during 6 months to 3 years followed up time. 3) The mean SVA was 78.0mm for patients in the A group and 24.0mm for those in the B group. At final follow up evaluation, no significant differences between the groups were found for the JOA score improvement ratio(74.3% vs 76.1%) or the VAS score for low-back pain(14.4 vs 9.4mm); the VAS score for leg pain was significantly higher for those in the A group(19.6mm) than for those in the B group(18.2mm); and the VAS score for leg numbness tended to be higher for those in the A group(22.7mm) than for those in the B group(21.6mm). Conclusion: 1) cervical thoracic lumbar sacral vertebral schwannoma according to different schwannoma growth type, the choice of semi-laminectomy with tumor resection can reduce Patients’ hospitalization days, improve days off the bed. 2) Postoperative cerebrospinal fluid leakage lumbar subarachnoid catheter is an effective method to shorten the treatment time. 3) Preoperative alignment of the spine in the sagittal plane did not affect JOA scores after laminotomy and schwannomas resection. However, low-back pain was worse for patients with preoperative anterior translation of the C-7 plumb line than for those without. Compared to patients with normal sagittal alignment prior to surgery(Group B: SVA<50mm), those with preoperative sagittal imbalance(Group A: SVA ≥ 50mm) had significantly smaller lumbar lordosis and larger pelvic tilt. In Group A, there was a significant decrease in postoperative SVA compared with the preoperative SVA. The patients in Group A with severe preoperative sagittal imbalance had residual sagittal imbalance after surgery.