Posterior inter-body fusion after spinal tumour resection

Microsurgical management of spinal schwannomas: evaluation of 128 cases

Object

The authors conducted a study to evaluate the clinical characteristics and surgical outcomes in patients with spinal schwannomas and without neurofibromatosis (NF).

Methods

The data obtained in 128 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. Karnofsky Performance Scale (KPS) scores were used to compare patient outcomes when examining the anatomical location and spinal level of the tumor. The neurological outcome was further assessed using the Medical Research Council (MRC) muscle testing scale.

Results

Altogether, 131 schwannomas were treated in 128 patients (76 males and 52 females; mean age 47.7 years). The peak prevalence is seen between the 3rd and 6th decades. Pain was the most common presenting symptom. Gross-total resection was achieved in 127 (97.0%) of the 131 lesions. The nerve root had to be sacrificed in 34 cases and resulted in minor sensory deficits in 16 patients (12.5%) and slight motor weakness (MRC Grade 3/5) in 3 (2.3%). The KPS scores and MRC grades were significantly higher at the time of last follow-up in all patient groups (p = 0.001 and p = 0.005, respectively).

Conclusions

Spinal schwannomas may occur at any level of the spinal axis and are most commonly intradural. The most frequent clinical presentation is pain. Most spinal schwannomas in non-NF cases can be resected totally without or with minor postoperative deficits. Preoperative autonomic dysfunction does not improve significantly after surgical management.

Alternative tricortical methods of screw implantation for anterior cervical plate fixation: a preliminary report

An experience with 26 cases of anterior cervical interbody plate fixation with an alternative method of screw implantation is described. The follow up ranges from 15 to 51 months. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but also, by virtue of their course, stabilise the two adjoining vertebral bodies by themselves. In five of these cases only tricortical screws without the metal plate were used for fixation. Cortico-cancellous iliac crest bone graft shredded into small pieces is placed between the vertebral bodies after adequately preparing the bed. A 100% bony union rate was achieved, with no morbidity or instrument fatigue or failure. The described technique of plate fixation appears to be biomechanically stronger. It provided a rigid segmental internal fixation permitting early mobilisation of the patient with minimal external support.