Spinal Schwannoma: An Analysis of 48 Surgical Cases

Introduction: Spinal schwannomas represent a quarter of intradural spinal tumors in adults. We hope to contribute to the body of clinical knowledge regarding spinal schwannomas in order to enhance care. In our analysis we sought to understand how the spatial occurrence of spinal schwannomas affects their clinical presentation and treatment course, as well as Iidentify variables with prognostic value.

Methods: A retrospective chart review was conducted of 48 cases of spinal schwannoma from 04/01/2015 - 05/01/2023 that were resected at Rhode Island Hospital.

Results: Cervical schwannomas were primarily associated with paresthesias (50%) and neck pain (33%). As for thoracic spinal schwannomas, 25% of patients reported paresthesias and 25% reported urinary incontinence. Patients with lumbar tumors were found to have mechanical and lumbar radicular pain in 31% and 19% of cases respectively. Sacral tumors presented with mechanical lumbar back pain (29%) and lumbar radicular symptoms (29%). Pre-operative mechanical lower back pain may predict postoperative emergency admission as 4 of 9 (44.44%) patients with preoperative mechanical pain were readmitted to the ED within 30 days of procedure. A benefit in ECOG score was seen across all spinal regions with patients with high cervical tumors seeing the largest average degree of benefit (-0.71 ECOG categories) and sacral patients seeing least degree of benefit with (-0.40 ECOG categories). We observed zero recurrences among our patients.

Conclusion : Spinal schwannomas are generally intradural extramedullary tumors which rarely recur after resection. They may be successfully treated with surgery alone without the need for radiation or systemic therapy. We found that mechanical lumbar back pain was a predictor of postoperative emergency readmission following spinal schwannoma resection. High cervical tumors saw the highest average decrease in ECOG score following resection.