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ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 53-59

A Study comparing open and minimally invasive surgery for one- or two-level thoracolumbar intradural extramedullary spine tumors


Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India

Correspondence Address:
Sreenath Kuniyil1
Department of Neurosurgery, Government Medical College, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


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Background: The era of modern minimally invasive spine (MIS) surgery begins in the early 1990s with the report of the first case of tubular discectomy. Later, intradural tumor excision was reported in 2006. But most of us are still reluctant in accepting this new corridor due to lack of studies from India. Aim: The aim of this study is to compare various aspects of minimally invasive resection of one- or two-spinal level thoracolumbar intradural extramedullary (IDEM) tumors with conventional open surgery. Materials and methods: This study was conducted in patients admitted with a diagnosis of IDEM spinal tumor during the period of January 2016 January 2019. We compared 19 cases of one- or two-spinal level thoracolumbar IDEM tumors operated through MIS with 19 similar cases operated through open surgery. Results: The mean intraoperative blood loss was 115 mL in the MIS group and 530 mL in the open group and the duration of surgery was 229.74 minutes for the MIS group and 230.26 minutes for the open group. The mean C arm exposure was 6.04 in the MIS group and 2.63 in the open group. Ten cases in the MIS group and eight cases in the open group were operated in one spinal level and 9 in the MIS group and 11 in the open group were operated in two spinal levels. One patient in both groups developed cerebrospinal fluid (CSF) leak and one patient in the MIS group and two patients in the open group had a postoperative wound infection. The mean postoperative pain score was 2 in the MIS group and 3.58 in the open group (assessed by the visual analog scale). Sensory and motor symptoms improved in all cases in both groups. The mean hospital stay was 5.16 days in the MIS group and 8.42 days in the open group. The mean size of incision was 2.73 in the MIS group and 8.18 in the open group. The patient satisfaction index (PSI 1–4) in terms of overall satisfaction was 1 (68.4%) and 2 (31.6%) in the MIS group and 1 (47.4%), 2 (31.6%), and 3 (21.1%) in the open group. Conclusion: We conclude that MIS procedures are a safe and better alternative for one- or two-level thoracolumbar IDEM spinal tumors but its usefulness in tumors with more than two-level needs further studies.


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