Microsurgical Resection Of Lumbar Intraspinal Tumor Through Paraspinal Approach Using Percutaneous Tubular Retractor System

Objective: To evaluate the clinical effect and operative skill of microsurgical resection of lumbar intraspinal tumor through paraspinal approach by percutaneous tubular retractor system.Methods and materials: A retrospective study was carried out to analyze 21 patients with lumbar intraspinal tumor between November 2011 and February 2014, including 19 cases of schwannoma and 2 case of meningioma, without lumbar instability in preoperative imaging examinations. The length of tumors was 0.6-2.0cm. Tracheal intubation anesthesia was done before they were treated by microsurgery using percutaneous tubular retractor system through paraspinal approach. Operation time, blood loss, postoperative wound pain duration and hospital stay were analyzed. Creatine phosphokinase(CPK-MM) level was recorded 1day preoperatively, 1 day, 3 days and 5 days postoperatively. Japanese Orthopaedic Association Scores(JOA) and visual analog scale(VAS) scores were analyzed at 1 day preoperatively, 1 day, 3days, 5 days and 6 months postoperatively to evaluate the spinal cord function status. CT three-dimensional reconstruction of lumbar vertebra was made 1 week postoperatively. MRI plain scan and enhanced scan of lumbar vertebra were achieved preoperatively, 1 week and 6 months postoperatively.Results: Complete removal of the tumors was done in all patients without spinal cord or nerve root injury. Post-operatively JOA and VAS scores improved compared with that before operation(p < 0.05). Level of CPK-MM increased 1 day postoperatively, descended to preoperative level 5days postoperatively, and the difference was not statistically significant(p > 0.05). No residual tumor and tumor recurrence occurred in MRI plain scan and enhanced scan. No postoperative spinal instability was found in CT three-dimensional reconstruction, and no spinal deformity occurred during 6-28 months’ follow-up. Conclusion: Microsurgical resection of lumbar intraspinal tumor using percutaneous tubular retractor system through paraspinal approach minimized resection and injury to paraspinal muscles, facet joint, spinous process and ligaments, with total resection. This technique has the advantages of small operation wound, short hospital stay, rapid recovery, and preservation of postoperative spinal stability.