Spinal Intradural Tumor Resection via Long-Segment Approaches and Clinical Long-Term Follow-Up

TL;DR

This study shows that removing large spinal tumors using long surgical approaches can lead to good outcomes without causing long-term spine instability.

Contribution

The study demonstrates that extensive surgical approaches for spinal tumors do not compromise spinal stability and can achieve good clinical results.

Findings

72.2% of patients reported pain improvement after surgery.

Most patients did not require secondary dorsal fixation for spinal instability.

Modified McCormick scores remained low pre- and post-surgery, indicating stable neurological function.

Abstract

Spinal intradural tumors can grow along multiple segments. Extensive approaches such as long-segment laminoplasties may be necessary to achieve the gold standard of gross total resection. Here, we present a comprehensive cohort study describing the satisfying clinical outcome of patients undergoing four or more segment approaches without requiring dorsal fixation for intradural tumor resection. The clinical outcomes are comparable to patients undergoing surgical treatment of short-segment approaches, and no patient underwent a secondary fixation for symptoms of mechanical instability.

Introduction: Spinal intradural tumors account for 15% of all CNS tumors. Typical tumor entities include ependymomas, astrocytomas, meningiomas, and neurinomas. In cases of multiple affected segments, extensive approaches may be necessary to achieve the gold standard of complete tumor resection. Methods: We performed a bicentric, retrospective cohort study of all patients equal to or older than 14 years who underwent multi-segment surgical treatment for spinal intradural tumors between 2007 and 2023 with approaches longer than four segments without instrumentation. We assessed the surgical technique and the clinical outcome regarding signs of symptomatic spinal instability. Children were excluded from our cohort. Results: In total, we analyzed 33 patients with a median age of 44 years and interquartile range IQR of 30–56 years, including the following tumors: 21 ependymomas, one subependymoma–ependymoma mixed tumor, two meningiomas, two astrocytomas, and seven patients with other entities. The median length of the approach was five spinal segments with a range of 4–14 and with the foremost localization in the cervical or thoracic spine. Laminoplasty was the most chosen approach (72.2%). The median time to follow-up was 13 months IQR (4–56 months). Comparing pre- and post-surgery outcomes, 72.2% of the patients (n = 24) reported pain improvement after surgery. The median modified McCormick scores pre- and post surgery were equal to II IQR (I–II) and II IQR (I–III), respectively. Discussion: We achieved satisfying results with long-segment approaches. In general, patients reported pain improvement after surgery and received similar low modified McCormick scores pre- and post surgery and did not undergo secondary dorsal fixation. Thus, we conclude that intradural tumor resection via extensive approaches does not seem to impair long-term spinal stability in our cohort.

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