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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 074-084
DOI: 10.1055/s-0042-1749127
Original Article

Minimally Invasive Tubular Retractor Surgery for Intradural Extramedullary Spinal Tumor Reduces Postoperative Degeneration of Paraspinal Muscle

Zhexi He
1   Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
2   Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
,
Cho Ying Li
1   Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
,
Calvin Hoi-Kwan Mak
1   Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
,
Tat Shing Tse
1   Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
,
Fung Ching Cheung
1   Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
› Author Affiliations Funding None.
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Abstract

Background Minimally invasive surgery (MIS) using a tubular retractor has been increasingly utilized in spinal surgery for degenerative conditions with the benefit of paraspinal muscle preservation. This benefit has not been previously reported for intradural extramedullary tumors using the MIS approach. In this study, we aimed to compare the degree of postoperative fatty degeneration in paraspinal muscle between MIS with tubular retractor (MIS) and open laminectomy (Open) for intradural extramedullary spinal tumors.

Methods This was a retrospective review conducted in a tertiary neurosurgical center from 2015 to 2019. The degree of paraspinal muscle fatty degeneration, as measured by Goutallier grade on postoperative magnetic resonance imaging (MRI), was analyzed, and the degree of excision, tumor recurrence rate, and chronic pain were compared between the two surgical approaches.

Results Among 9 patients in the MIS group and 33 patients in the Open group, the rate of gross total resection was comparable (MIS: 100.0%, Open: 97.0%, p = 1.000). The degree of paraspinal muscle fatty degeneration was significantly reduced in the MIS group (median Goutallier grade 1 in MIS group vs. median Goutallier grade 2 in Open group, p = 0.023). There was no significant difference in the tumor recurrence rate, complication rate, and chronic pain severity. A consistent trend of reduced analgesic consumption was observed in the MIS group, though not statistically significant.

Conclusions Minimally invasive tubular retractor surgery is an effective approach for appropriately selected intradural extramedullary spinal tumors with significantly reduced postoperative fatty degeneration in paraspinal muscle.

Keywords

laminectomy - magnetic resonance imaging - minimally invasive surgical procedures - paraspinal muscles - spinal neoplasms

Availability of Data and Material

The data that support the findings of this study are available on request from the corresponding author, under the regulations from the Research Ethics Committee of Kowloon Central/Kowloon East (Ref: KC/KE-21–0150/ER-3) under the Hong Kong Hospital Authority.


Ethical Approval

This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study protocol was reviewed and was approved by the Research Ethics Committee of Kowloon Central/Kowloon East (Ref: KC/KE-21–0150/ER-3).


Consent to Participate

This retrospective study protocol and statistical methods were reviewed and approved by the Research Ethics Committee of Kowloon Central/Kowloon East (Ref: KC/KE-21–0150/ER-3) with the patient consent waived.




Publication History

Article published online:
06 July 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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