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Resection of Intradural Tumors at the Thoracolumbar Junction: Laminectomy with or without Instrumented Fusion?

Friday, May 3, 2024

Presenting Author(s)

VA

Vardhaan S. Ambati, MS

Medical Student
University of California San Francisco
San Jose, California, United States

Co-Author(s)

Alexander A. Aabedi, MD

Resident Physician
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Christopher P. Ames, MD

Neurosurgeon
University of California, San Francisco
San Francisco, California, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
TC

Timothy Chryssikos, MD, PHD

Assistant Professor
UCSF
Baltimore, Maryland, United States
AC

Aaron J. Clark, MD, PhD

Associate Professor
UCSF
San Francisco, California, United States
Sanjay S. Dhall, MD

Professor, Chief of Neurosurgery
Harbor UCLA Medical Center
PALOS VERDES ESTATES, CA, US
Alysha Jamieson, BA

Research Analyst
University of California San Francisco
Raynham, Massachusetts, United States
Nishanth Krishnan, BS

Medical Student
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Vijay L. Letchuman, MD

Neurosurgery resident
UCSF
San Francisco, CA, US
Mohamed Macki, MD, MPH

Neurosurgeon
Cleveland Clinic
San Francisco, California, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Irene Say, MD

Assistant Professor
UCSF
Sacramento, California, United States
LT

Lee Tan, MD

Attending Surgeon
UCSF
Indianapolis, Indiana, United States
Michael E. Tawil, BS

Medical Student
University of California San Francisco
San Francisco, CA, US

Introduction: When resecting thoracolumbar intradural tumors, surgeons must weigh the risk of increased instability with laminectomy alone with hardware complications and MRI metal artifact, which may interfere with monitoring for tumor recurrence/progression. We aim to compare revision/reoperation rates following laminectomy with and without fusion for thoracolumbar junctional intradural tumors.

Methods: A retrospective review identified patients treated at a single quaternary care institution (2012-2023) for resection of intradural tumors at T10-L1. Reoperation rate following laminectomy with or without instrumented fusion was the primary outcome.

Results: In total, 76 patients (43 females) underwent resection for thoracolumbar junctional intradural tumors (58 extramedullary, 18 intramedullary). Mean follow-up was 1.8 years. Sixty-two (80.0%) underwent laminectomy alone, while 24 (20.0%) underwent laminectomy with instrumented fusion. No fusion cohort was younger (51.2 vs 62.3 years, p=0.02). There were no significant differences between the laminectomy alone and laminectomy with fusion cohorts in gender and BMI. The laminectomy without and with fusion cohorts had similar distribution of intramedullary/extramedullary tumors (intramedullary: 28.0% vs 6.7%, p=0.08) and tumor types: schwannoma, ependymoma, and meningioma (p>0.05). Surgically, patients without and with fusion had similar operative time, number of laminectomies (2.5±1.1 vs. 2.9±1.0), and gross total resection rate (72.1%. vs 86.7%)(p>0.05). In the fusion cohort, mean levels fused was 2.6. Importantly, the fusion cohort had higher mean blood loss (426.7±446.0 vs 144.5±985 ml, p< 0.001). Laminectomy with and without fusion had similar rates of reoperation (13.3% vs 6.6%, p=0.383). Indications for reoperation included postoperative hematoma (2), pseudomeningocele (1), pseudarthrosis (1-fusion cohort), tumor recurrence (1), and CSF leak (1).

Conclusion : Laminectomy and fusion resulted in increased intraoperative blood loss. However, the incidence of revision/reoperation was similarly low in patients undergoing laminectomy with or without fusion for resection of thoracolumbar junction intradural tumors. Importantly, laminectomy alone did not result in increased rates of symptomatic instability.