Factors Affecting Postoperative Neurological Deficits After Nerve Root Resection for the Treatment of Spinal Intradural Schwannomas.

STUDY

DESIGN

A retrospective clinical data analysis.

OBJECTIVE

To investigate the factors related to postoperative neurological deficits after nerve root resection in the treatment of spinal intradural schwannoma.

SUMMARY OF BACKGROUND DATA: Neurological deficits could be observed after resection of tumor-involved nerve roots in spinal intradural schwannoma. Thus, it is important to find the factors related to postoperative neurological deficits.

METHODS

Clinical and pathological data were selected from patients underwent total resection of the solitary spinal intradural schwannoma from T11 to S. Patients were divided into the postoperative neurological deficits positive group (PND group, n = 12) and negative group (non-PND group, n = 52). Clinical features including age, sex, duration of disorders, diabetes, preoperative visual analogue scale (VAS) and SF-36 score, preoperative symptoms, tumor size, tumor location, and immunostaining results were analyzed.

RESULTS

Age, sex, duration of disorders, diabetes, preoperative VAS and SF-36 score, tumor length, and tumor-occupied ratio were not significantly different between the two groups (P > 0.05). Lower extremity pain, sensory disturbance, and motor disturbance were found in 25.0%, 50.0%, and 75.0% of patients in the PND group and 76.9%, 17.3%, and 7.7% of patients in the non-PND group, respectively, and the results were significantly different (P < 0.05). The rate of postoperative neurological deficits was higher when the tumor was located in the thoracolumbar junction (T11-L2) than other segments (L2-S; P = 0.009). For immunostaining study, CD34-positive rate was significantly different between the two groups (P = 0.013).

CONCLUSION

The absence of preoperative lower extremity pain, presence of sensory and motor disturbances, and tumor location in the thoracolumbar junction (T11-L2) are the predictors of postoperative neurological deficits. Age, sex, duration of the disorders, diabetes, preoperative VAS score, preoperative SF-36 score, tumor length, and tumor-occupied ratio are not related to postoperative neurological deficits. On immunostaining of tumors, CD34-negative results are related to the development of postoperative neurological deficits.

LEVEL OF EVIDENCE: 4.