The Classification Of Lumbar Intraspinal And Extraspinal Communicating Tumors And The Microsurgery Strategy

Objective: The purpose of this study is to discuss the classification of lumbar intraspinal and extraspinal communicating tumors and the microsurgery strategy according to the classification.Methods:A retrospective study was carried out to analyze 32 patients with lumbar intraspinal and extraspinal communicating tumors between March 2013 and March 2016.According to the location of tumors and our microsurgery experience for the treatment of lumbar spinal tumors,we divided the lumbar intraspinal and extraspinal communicating tumors into type ?,type ?,type ? and different types are suitable for different microsurgery strategy.Operation time,blood loss,and hospital stay were analyzed.Creatine phosphokinase(CPK-MM)level was recorded 1 day 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,3months and 6 months postoperatively to evaluate the spinal cord function status.CT three-dimensional reconstruction and MRI plain scan and enhanced scan of lumbar vertebra were achieved 1 week preoperatively,1 week,3 months,6 months and 12 months postoperatively.Results:In this group,there were 10 cases of type ?,including 3 cases of type ?a,7 cases of type ?b,16 cases of type ?,including 6 cases of type ?a,10 cases of type ?b,and 6 cases of type ?.All 32 patients underwent primary resection.Operation time were 115-241 min and an average at 155.30± 48.40 min.Blood loss were 20-125 ml and an average at 45.12± 18.70 ml.Postoperative hospital stay were 4-9 days and an average at 5.50± 1.52 days.All patients were followed up(12-24 months,mean 18.3 months).The level of CPK-MM increased significantly(498.70±48.35)IU/ml)on the 1 day after operation,and reached(151.79±11.58)IU/ml on the 5 days after operation,which was close to the normal level before operation(P > 0.05).JOA score increased from 1 day(11.24±2.83)before operation to 6 months(26.53±1.24)after operation(P < 0.05),and VAS score decreased from 1 day(6.80± 1.34)before operation to 6 months(0.51± 0.42)after operation(P < 0.05).The symptoms of 32 patients were improved significantly after operation,however,one patient suffered from right lower extremity pain again 9 months after operation.Re-examination of MRI revealed recurrence of the tumors and secondary surgery was performed.In the follow-up period,no recurrence of lumbar spine tumors was observed on MRI in other patients and no lumbar spine instability was observed on CT three-dimensional reconstruction.Conclusion: The reasonably classification of lumbar intraspinal and extraspinal communicating tumors and select the appropriate microsurgical treatment strategy according to the classification,we can resect the tumors in one stage on the basis of protecting the nerve function,and the spinal stability can be maintained to the greatest extent.Thus achieving good clinical therapeutic effect,which has certain guiding significance for the surgical treatment of lumbar intraspinal and extraspinal communicating tumors.