Spinal tümörler nedeniyle ameliyat edilen 101 hastanın retrospektif kohort analizi: Tek merkez deneyimi

Amaç: Spinal tümörlerin tedavi stratejileri ve sonuçlarına genel bir bakış sağlamak amacıyla kliniğimizde opere edilen spinal tümör olgularının klinik ve cerrahi sonuçlarını literatür eşliğinde değerlendirmektir. Yöntemler: Ocak 2015 - Ocak 2020 tarihleri arasında kurumumuzda mikrocerrahi rezeksiyon uygulanan 101 spinal tümör hastası retrospektif olarak incelendi. Hastaların klinikleri, demografik bilgileri, görüntüleme yöntemleri, cerrahi yaklaşımlar, nöropatolojik tanı, postoperatif takip ve komplikasyonlardan oluşan veriler ve postoperatif nörolojik durumlar hakkındaki veriler toplandı. Hastaların nörolojik durumlarını değerlendirmek için Frankel skalası kullanıldı. Bulgular: 47 erkek ve 54 kadın hasta ortalama 14.2 ay takip edildi. Yerleşim yerlerine göre intradural ekstramedüller (% 51.5), ekstradural (% 36.6) ve intramedüller tümörler (% 11.9) oranda görüldü. En sık yerleşim yeri torasik (n = 47), ardından lomber bölgeydi (n = 26). En sık görülen histopatolojik tanı schwannoma (n = 27), menenjiyom (n = 19), metastaz (n = 19) ve ependimoma (n = 11) idi. Frankel skalasına göre, iki olgunun derecesinde azalma, 26 olgunun derecesinde artış olmuştu ve 73 olgunun derecesinde ise değişiklik olmamıştı. Hastaların magnetik rezonans görüntüleme takiplerinde % 32.7 rezidüel tümör, % 5.9 rekürrens ve % 5.9 progresyon olduğu görüldü. Sonuç: Gelişen preoperatif tanı yöntemleri, peroperatif araç ve gereçlerdeki teknolojik gelişmeler ve cerrahi tekniklerin gelişmesine rağmen, preoperatif nörolojik durum spinal tümörler için postoperatif fonksiyonun hala en güçlü prediktörü olmaya devam etmektedir. Ayrıca postoperatif takip sırasında hastalara yapılan erken magnetik rezonans görüntüleme incelemelerinin de nüks ve progresyon oranlarını belirlemede de önemlidir.

Anahtar Kelimeler:

Spinal tümör, Frankel skalası

Retrospective cohort analysis of 101 patients who underwent surgery due to spinal tumors: A single-center experience

Aim: To evaluate the clinical and surgical outcomes of the spinal tumor cases operated in our clinic. Methods: A total of 121 spinal lesions operated between January 2015 and January 2020 were retrospectively analyzed. Our study included 101 pathologically diagnosed patients. Results: Of the 101 patients, 47 were males and 54 were females. The youngest patient was 4 months old, the oldest was 82 years old (Mean 46.56 ± 19.05). A total of 52 patients presented with neurological deficits: 6 were Frankel A, 9 were Frankel B, 15 were Frankel C, and 22 were Frankel D. The thoracic region was the most frequently affected area (46.5%). It was observed that intradural extramedullary (51.5%), followed by extradural (36.6%) and then intramedullary (11.9%) were the most common. According to the pathological diagnosis, Schwannoma (n: 27), meningioma (n: 19), ependymoma (n: 11), metastasis (n: 19), lymphoma (n: 6), and other tumors (n: 19) were observed. According to the Frankel Scale, there was a decrease in the grade of 2 cases, an increase in the grade of 26 cases and no change in the grade of 73 cases. During follow-up with the patients MRI, it was observed that 32.7% cases had residual tumors, recurrence developed in 5.9% of cases, and progression occured in 5.9% of cases. Conclusion: Less neurological deficits were observed in our patients despite the aggressive management with the technology used. In addition, improvement in their neurological deficits were observed in the long term due to improved physical therapy.Therefore, developing technology, surgical experience, and aggressive surgical inference with postoperative physiotherapy should be considered.

Keywords:

Spinal tumor, Frankel Scale histopathological diagnosis, magnetic resonance imaging,

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1- Thakur NA, Daniels AH, Schiller J, et al. Benign tumors of the spine. J Am Acad Orthop Surg. 2012;20(11):715-724.
2- Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Tumors of the spine. World J Orthop. 2016;7(2):109 116.
3- Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol. 2004;50(2):159-176.
4- Ahn DK, Park HS, Choi DJ, Kim KS, Kim TW, Park SY. The surgical treatment for spinal intradural extramedullary tumors. Clin Orthop Surg. 2009;1(3):165-172.
5- Sellin JN, Tatsui CE, Rhines LD. Assessment and treatment of benign intradural extramedullary tumors. In: Winn HR, editor. Youmans & Winn Neurological Surgery. 7th ed. Philadelphia: Elsevier; 2017. p. 2428‑34.e2.
6- Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI. Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus. 2015;39(2):E14.
7- Fachrisal, Setiawan E, Alhuraiby SS. Functional outcome in intradural extramedullary tumor patients: Case series. Ann Med Surg (Lond). 2020;54:71-73.
8- Ahlhelm FJ, Fries P, Nabhan A, Reith W. Spinale Tumoren [Spinal tumors]. Radiologe. 2010;50(2):165-180.
9- Maher de Leon ME, Schnell S, Rozental JM. Tumors of the spine and spinal cord. Seminars in Oneology Nursing. 1998;14(1):43-52.
10- Adeolu AA, Oyemolade TA, Salami AA, et al. Features and Outcome of Surgical Management of Spinal Tumors in a Cohort of Nigerian Patients. World Neurosurg. 2015;84(4):1090-1094.
11- Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol. 2004;50(2):159-176.
12- Dinç C, İplikçioğlu CA, Tufan A, Özek E. Spinal İntradural Tümörler. Sinir Sistemi Cerrahisi Derg.2014; 4(2):57-63.
13- Barzilai O, Fisher CG, Bilsky MH. State of the Art Treatment of Spinal Metastatic Disease. Neurosurgery. 2018;82(6):757-769.
14- Bellut D, Burkhardt JK, Mannion AF, Porchet F. Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale. Neurosurg Focus. 2015;39(2):E2.
15- Moein P, Behnamfar O, Khalighinejad N, et al. A 12-year epidemiologic study on primary spinal cord tumors in Isfahan, Iran. J Res Med Sci. 2013;18(1):17-21.
16- Hirano K, Imagama S, Sato K, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J. 2012;21(10):2019-2026.
17- Elmesallamy, W.A.A., Taha, M.M. Surgical management and prognostic factors of spinal metastatic tumors. Egypt J Neurosurg 35, 7 (2020). https://doi.org/10.1186/s41984-020-00080-z
18- Balériaux DL. Spinal cord tumors. Eur Radiol. 1999;9(7):1252-1258.
19- Newton HB, Newton CL, Gatens C, Hebert R, Pack R. Spinal cord tumors: review of etiology, diagnosis, and multidisciplinary approach to treatment. Cancer Pract. 1995;3(4):207-218.
20- Preston-Martin S. Descriptive epidemiology of primary tumors of the spinal cord and spinal meninges in Los Angeles County, 1972-1985. Neuroepidemiology. 1990;9(2):106-111.
21- Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Lower urinary tract dysfunctions in patients with spinal cord tumors. Neurourol Urodyn. 2004;23(1):68-75.
22- Wager M, Lapierre F, Blanc JL, Listrat A, Bataille B. Cauda equina tumors: a French multicenter retrospective review of 231 adult cases and review of the literature. Neurosurg Rev. 2000;23(3):119-131.
23- Witham TF, Khavkin YA, Gallia GL, Wolinsky JP, Gokaslan ZL. Surgery insight: Current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol 2006;2:87‑94.
24- Klimo P Jr., Schmidt MH. Surgical management of spinal metastases. Oncologist 2004;9:188‑96.
25-R3-Bailar JC 3rd, Gornik HL. Cancer undefeated. N Engl J Med. 1997;336(22):1569-1574.
26- North RB, Larocca VR, Schwartz J, et al. Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience. J Neurosurg Spine. 2005;2(5):564-573
27- Engelhard HH, Villano JL, Porter KR, et al. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine. 2010;13(1):67-77.
28- Helseth A, Mørk SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg. 1989;71(6):842-845.
29- Alizada O, Kemerdere R, Ulu MO, et al. Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution. J Clin Neurosci. 2020;73:201-208.
30- Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci. 2009;9 Suppl 1:40-45.
31- Abdel-Wahab M, Etuk B, Palermo J, Shirato H, Kresl J, Yapicier O, et al: Spinal cord gliomas: A multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys.2006; 64:1060– 1071.
32- Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93(2 Suppl):183-193.
33- Epstein FJ, Farmer JP, Freed D: Adult intramedullary astrocytomas of the spinal cord. J Neurosurg.1992; 77:355–359.
34- Schwartz TH, McCormick PC: Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis. J Neurooncol.2000; 47:211–218.
35- Sandler HM, Papadopoulos SM, Thornton AF Jr, Ross DA: Spinal cord astrocytomas: results of therapy. Neurosurgery.1992; 30: 490–493.
36- Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine. 2017;42(10):789-797.
37- Hikata T, Isogai N, Shiono Y, et al. A Retrospective cohort study comparing the safety and efficacy of minimally invasive versus open surgical techniques in the treatment of spinal metastases. Clin Spine Surg. 2017;30(8):E1082- E1087.
38- Molina C, Rory Goodwin C, Abu-Bonsrah N, Elder BD, De La Garza Ramos R, Sciubba DM. Posterior approaches for symptomatic metastatic spinal cord compression. Neurosurg Focus. 2016;41(2):E11.
39- Chikani MC, Okwunodulu O, Mesi M, Mezue WC, Ohaegbulam SC, Ndubuisi CC. Surgically Treated Primary Spinal Cord Neoplasms in Southeastern Nigeria. J Neurosci Rural Pract 2018;9:137‑9.
40- Bartels RH, van der Linden YM, van der Graaf WT. Spinal extradural metastasis: Review of current treatment options. CA Cancer J Clin 2008;58:245‑59.
41- Ottenhausen M, Ntoulias G, Bodhinayake I, et al. Intradural spinal tumors in adults-update on management and outcome. Neurosurg Rev. 2019;42(2):371-388.
42- Abd-El-Barr MM, Huang KT, Moses ZB, Iorgulescu JB, Chi JH. Recent advances in intradural spinal tumors. Neuro Oncol. 2018;20(6):729-742.
43- Dunning EC, Butler JS, Morris S: Complications in the management of metastatic spinal disease. World J Orthop 3:114-121, 2012
44- Klimo P Jr, Schmidt MH: Surgical management of spinal metastases. Oncologist.2004; 9:188-196.
45- Matsumoto Y, Harimaya K, Doi T, Maeda T, Iwamoto Y: Outcome of osteoplastic laminotomy for excision of spinal cord tumours. J Orthop Surg (Hong Kong)2009; 17:275-279.
46- Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7(3):179-192.
47- Kim RY, Spencer SA, Meredith RF, et al. Extradural spinal cord compression:analysis of factors determining functional prognosis prospective study. Radiology 1990;176(1):279–82.
48- Zairi F, Vieillard MH, Devos P, Aboukais R, Gras L, Assaker R. Management of neoplastic spinal tumors in a spine surgery care unit. Clin Neurol Neurosurg. 2015;128:35-40.
49- Strickland BA, McCutcheon IE, Chakrabarti I, Rhines LD, Weinberg JS. The surgical treatment of metastatic spine tumors within the intramedullary compartment. J Neurosurg Spine. 2018;28(1):79-87.