Abstract
Introduction
Neuroimaging technology, micro-surgical instruments and minimally invasive techniques have allowed the development of new approaches that maintain favorable neurological outcome obtained by conventional techniques in resection of spinal neoplasm. Our work describes a new surgical technique for patients with spinal intra-canal neoplasms in order preserve muscle tension band posterior ligamentous and assessed the results.
Material and Methods
Our surgical technique proposes a para-median posterior minimally invasive approach from linear incision of 2.5 cm ipsilateral to the site of the lesion trough an expandable tubular retractor. Patients were followed prospectively with visits at one, three, six and twelve months after surgery. Surgical time, blood loss, intra-operative and post-operative complications, hospital length of stay, pre and post-operative neurological status were assessed.
Results
We describe the surgical treatment technique in twenty one patients diagnosed with spinal intra-canal compressive lesions, which underwent surgical resection between January 2010 and July 2015. The Meningioma was the most frequent neoplasm. The means surgical time was 148 minute. The average intraoperative bleeding was 217 ml. Patients experienced minimal postoperative pain and they were discharged in average 31 hours after surgery. There were no intraoperative complications; though two patients developed complications in the late postoperative period. A patient had cerebrospinal fluid leak and other patient developed myelopathy secondary to non-infectious arachnoiditis.
Conclusion
This type of approach technique provides adequate visualization and microsurgical resection of the intra-canal tumor lesions, with reduced muscle denervation and devascularization by preserving the tension of the ligament complex. These results correlate with previous studies of minimally invasive techniques for spinal neoplasms.