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Title: [Resection of lumbar nerve sheath tumors via muscle-pedicle open-door laminoplasty approach].
Author: Zheng XJ, Liu XZ, Kou JQ, Sun YL, Liu XY, Guo JW, Wang T.
Journal: Zhonghua Yi Xue Za Zhi; 2019 Oct 15; 99(38):3000-3004. PubMed ID: 31607032.
Abstract:
Objective: To evaluate the efficacy and safety of resection of lumbar nerve sheath tumors via muscle-pedicle open-door laminoplasty approach. Methods: From March 2016 to June 2018, 6 patients (4 males and 2 females, average age (45±14) years) with lumbar spinal nerve sheath tumors received surgical treatment via muscle-pedicleopen-door laminoplasty approach in the Department of Spinal Surgery, the Affiliated Hospital of Qingdao University. The operation time, blood loss, cerebral spinal fluid (CSF) leakage, and pre- and post-operative Oswestry Disability Index (ODI) and low back and leg pain visual analogue scale (VAS) were recorded for all patients. Cobb angle of lumbar lordosis was measured on the standing lateral X-ray before and 6 months after surgery. Bone fusion was observed in computed tomography at six months after surgery. Results: Total tumor resection was achieved in all the 6 patients. The operation time was from 76 to 117 minutes (average, (102±15) minutes). The blood loss was from 160 to 280 ml (average, (256±24) ml). No CSF leakage was observed in this cohort.All patients were followed up for more than 6 months. ODI and VAS for low back and leg pain were much better at one month after operation than those before the operation(t=7.70, 8.63,11.31, all P<0.05). The Cobb angle of lumbar lordosis before operation and at six months after the operation were comparable in all six patients(t=0.70, P>0.05). Bone fusion was observed in computed tomography at six months after surgery. No bone necrosis or absorption, no lamina dislodgement or spinal stenosis was occurred. Conclusions: The muscle-pedicle open-door laminoplasty approach is proved effective and safe to incise nerve sheath tumors in the lumbar spine. Some blood supply of lamina can be kept intact to accelerate bone fusion. 目的： 探讨经带肌蒂的单开门椎板成形入路切除腰椎管内神经鞘瘤的安全性和有效性。 方法： 纳入2016年3月至2018年6月青岛大学附属医院市南院区脊柱外科收治的6例腰椎椎管内神经鞘瘤患者，所有患者均采用经带肌蒂的单开门椎板成形手术入路切除肿瘤。患者中男4例，女2例，年龄（45±14）岁。每例患者均记录是否能完整切除肿瘤、手术时间、出血量、是否有脑脊液漏，手术前后Oswestry功能障碍指数（ODI）和腰腿痛视觉模拟评分（VAS）变化情况，术前及术后6个月时行站立位腰椎X线片了解腰椎前凸Cobb角改变情况，术后6个月CT检查了解椎板愈合和椎板移位情况。手术前后临床资料比较采用配对t检验。 结果： 6例患者肿瘤均顺利完整切除，手术时间为76~117 mins，平均（102±15）mins。出血160~280 ml，平均（256±24）ml。6例患者术后均无脑脊液漏。所有患者均至少随访至术后6个月。术后1个月时ODI和腰痛及腿痛VAS评分均明显好于术前（t=7.70、8.63、11.31，均P<0.05）。术后6个月时腰椎前凸与术前比较差异无统计学意义（t=0.70，P>0.05）。术后6个月时CT随访时椎板缺损处已愈合，椎板无明显缺血坏死表现，无椎板移位和继发性椎管狭窄。 结论： 通过带肌蒂的单开门椎板成形入路可安全有效地切除腰椎管内硬膜下神经鞘瘤，由于保留了部分椎板的血运，在不需要内固定的情况下，椎板愈合时间明显缩短。.

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