The Safety And Outcomes Between Keyhole Surgery And Total Laminectomy For Resection Of Intradural Extramedullary Spinal Cord Tumors

Objective To compare the safety and outcomes between keyhole surgery and total laminectomy for resection of intradural extramedullary spinal cord tumors.Methods Retrospectively collected the clinical data of 102 patients with intradural extramedullary spinal cord tumors(≤3cm)treated by surgery in our department from January 2014 to January 2017.There were 13 cases of cervical tumors,45 cases of thoracic tumors,and 44 cases of lumbar tumors(L1).50 cases underwent the keyhole surgery and the other 52 received total laminectomy.The age,gender,operation time,volume of intraoperative bleeding,the leaving bed time,the length of postoperative hospital stay,drainage,postoperative complications,intraoperative neuroelectrophysiological monitoring(IONM),preoperative and postoperative visual analogue score(VAS),neck disability index(NDI),oswestry disability index(ODI),Mc Cormick spinal cord function grading were analyzed to evaluate the safety and clinical outcomes of two groups.Results Both groups were followed up.The keyhole group was followed up for(29.95±14.79)months and the total laminectomy group was followed up for(44.92±14.78)months.The tumors were completely resected in all cases.All the incision healed well and no cerebrospinal fluid leakage were occurred.Baseline data,operation time,the results of IONM,preoperative and 3 months,6 months,12 months postoperative VAS,NDI(cervical tumors),ODI(thoracic and lumbar tumors),tumor recurrence between two groups were no statistically significant differences(all P>0.05).The keyhole group had less volume of intraoperative bleeding than the total laminectomy group [(73.20±23.62)ml vs(135.96±26.50)ml,P<0.05],earlier postoperative leaving bed time [(1.40±0.57)d vs(6.48±0.98)d,P<0.05],and the postoperative hospital stay was shorter [(4.32±0.84)d vs(11.17±2.01)d,P<0.05],and it is more advantageous in terms of drainage [ 0/50 vs 52/52,P<0.05 ].The keyhole group had significantly improved in VAS [(1.76±0.74)vs(2.62±0.63),P<0.05 ],NDI[(10.83±0.75)vs(15.29±3.20),P<0.05 ],ODI [(11.47±4.44)vs(14.49±3.29),P<0.05 ] than those in the total lamincetomy group at 2 weeks postoperative.No significant differences were found in Mc Cormick spinal cord function grading preoperative and 2 weeks,3 months,6 months,12 months postoperative between two groups(all P>0.05).Conclusion Compared with the total laminectomy,keyhole surgery is suitable for the treatment of intradural extramedullary spinal cord tumors with small size and limited location,and it is equivalently safe in resecting the tumors,with less bleeding,no drainage,earlier leaving bed time,shorter postoperative hospital stay,less postoperative pain,and faster functional recovery.However the long-term outcomes are similar.