Unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen: evaluation of spinal stabilization

doi:10.3969/j.issn.2095-4344.2014.13.018

Abstract

Abstract:

BACKGROUND: The choice of schwannoma resection is strongly associated with whether the tumor was completely resected, whether stretch during resection injures spinal nerves, and finally with the prognosis of treatment.
OBJECTIVE: To evaluate the spinal stabilization after laminectomy combining unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen.
METHODS: A total of 48 cases of schwannoma in the spinal canal or intervertebral foramen of neck, chest and waist underwent laminectomy combining unilateral or bilateral nail-rod system. 34 cases in spinal canal received bilateral nail-rod system, and 14 cases in the intervertebral foramen received unilateral nail-rod system.
RESULTS AND CONCLUSION: At 3 days and 3, 6, 12 months after internal fixation, radiograph results demonstrated that location of implants was good. Bone graft fusion was found. No spinal instability and vertebral slippage occurred. Neural functional score Bodford (1997) and quality of life score were significantly increased
after treatment (P < 0.01). Muscle strength assessed by Lovett grade was significantly elevated after treatment (P < 0.01). Pain evaluated by Virtual Rescan grade was significantly lessened after treatment (P < 0.01). Schwannoma was completely resected in 48 patients. After treatment, six patients affected leakage of cerebrospinal fluid. One case experienced infection of cerebrospinal fluid. One case had to undergo secondary operation due to the infection. Three cases received nerve root resection due to tumor erosion. These experimental results confirmed that laminectomy combining unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen has the advantage of the tumor fully exposed to the operator, which can help completely resect schwannoma and effectively avoid spinal nerve injury. Even more important thing is that the spinal stability is reconstructed by unilateral or bilateral nail-rod system, which prevents the occurrence of vertebral slippage and vertebral destabilization. Long-term effect still needs further research.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: neurilemmoma, lumbar vertebrae, internal fixators

CLC Number:

R318

Zhang Peng, Wang Ting, Qu Shao-zheng, Zhang Jin-feng, Li Shu-zhong . Unilateral or bilateral nail-rod system for schwannoma in the spinal canal or intervertebral foramen: evaluation of spinal stabilization[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 2071-2076.

Figures/Tables 2

2.1 参与者数量分析纳入患者48例，随访时间为内固定后3-13个月，平均9.9个月，全部进入结果分析。 2.2 患者治疗后X射线复查脊柱稳定性结果所有患者内固定后3 d内置物位置良好，无脊柱失稳、椎体滑脱现象。内固定后3个月示：内置物位置良好，植骨基本融合，无脊柱失稳、椎体滑脱现象。内固定后6个月示：植骨融合，脊柱稳定性良好。 2.3 患者治疗后肌力采用Lovett分级内固定前Ⅰ级1例、Ⅱ级3例、Ⅲ级6例、Ⅳ级30例、Ⅴ级8例，内固定后Ⅲ级1例、Ⅳ级4例、Ⅴ级43例，内固定前后比较差异有显著性意义(P < 0.01，表1)。 2.4 患者治疗后疼痛VRS分级内固定前1级、Ⅰ级4例、Ⅱ级28例、Ⅲ级15例，内固定后0级33级、Ⅰ级14例、Ⅱ级1例，内固定前后比较差异有显著性意义(P < 0.01，表1)。 2.5 患者治疗后神经功能采用Bodford(1997)评分结果内固定前41-60分8例、61-80分37例、81-100分3例，内固定后41-60分0例、61-80分4例、81-100分44例，内固定前后比较差异有显著性意义(P < 0.01，表2)。 2.6 患者治疗后生活质量评估内固定前20-40分3例、41-60分12例、61-80分31例、81-100分2例，内固定后41-60分12例、61-80分4例、81-100分4例，内固定前后比较差异有显著性意义(P < 0.01，表2)。 2.7 并发症 48例患者均获得完整切除，病理证实均为神经鞘瘤。治疗后有6例出现脑脊液漏，1例出现脑脊液感染，有1例因脑脊液感染行二次手术，有3例因肿瘤侵蚀神经根行肿瘤神经根一并切除。 2.8 典型病例分析例1：患者女，64岁，以查体发现腰椎肿物2年收入院，诊断：L1/2右侧椎间孔区肿瘤。于2010-12-10全麻下行腰椎后路L1/2右侧半椎板切除、肿瘤切除内固定。治疗后后病理证实为：神经鞘瘤。治疗后复查腰椎正侧位片示：内植物位置良好，脊柱稳定，牢固(图1)。例2：患者女，51岁，因腰骶部疼痛5个月，加重伴双下肢麻痛6 d收入院，MRI示：L4/5椎管水平占位性病变。于2012-04-08行腰椎后路肿物切除植骨内固定。病理显示：腰椎管内神经鞘瘤。内固定后患者疼痛症状消失，麻木症状缓解。复查腰椎正侧位X射线示：内植物位置良好，植骨融合，脊柱稳定牢固(图2)。"

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