Predictors of clinical and structural outcomes after surgery for spinal nerve sheath tumor resection: a retrospective analysis

Adam S. Levy Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida

Search for other papers by Adam S. Levy in
jns
Google Scholar
PubMed
Close
 BS
,
Aria M. Jamshidi Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida

Search for other papers by Aria M. Jamshidi in
jns
Google Scholar
PubMed
Close
 MD
,
Martin A. Merenzon Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida

Search for other papers by Martin A. Merenzon in
jns
Google Scholar
PubMed
Close
 MD
,
David J. Levi Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida

Search for other papers by David J. Levi in
jns
Google Scholar
PubMed
Close
 BAE
, and
Allan D. Levi Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida

Search for other papers by Allan D. Levi in
jns
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $392.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $392.00
USD  $636.00
Print or Print + Online Sign in

OBJECTIVE

Resection of spinal nerve sheath tumors (SNSTs) typically necessitates laminectomy, often with facetectomy, for adequate exposure of tumor. While removal of bone affords a greater operative window and extent of resection, it places the patient at greater risk for spinal instability. Although studies have identified risk factors for fusion at the time of tumor resection, there has yet to be a study assessing long-term stability following SNST resection. In this study, the authors sought to identify preoperative and operative risk factors that predispose to long-term spinal instability and investigate clinical variables associated with greater risk for subsequent fusion in the time following initial SNST resection.

METHODS

An institutional registry of spinal surgeries was queried at a single institution over a 20-year period. Demographic, clinical, and operative variables were recorded retrospectively and investigated for predictive value of several postoperative sequelae.

RESULTS

A total of 122 SNST cases among 112 patients were included. At a mean follow-up time of 27.7 months, patients with a history of neurofibromatosis type 2 (NF2) (p = 0.014) and those who had undergone a laminectomy of ≥ 4 levels at the time of initial SNST resection (p = 0.028) were more likely to present with some degree of structural abnormality or neurological deficit following their initial surgery. The presence of facetectomy, degree of laminectomy, and level of spinal surgery were not found to be predictors of future instability. Ultimately, there was no significant predictor for true spinal instability following index surgery without fusion. A secondary analysis showed that an entirely extradural location (p = 0.044) and facetectomy at index surgery (p = 0.012) were predictive of fusion being performed at the time of tumor resection. Four of the 112 patients required fusion after their index SNST resection, 3 of whom underwent fusion for instability at the level of the index surgery. No variables were identified as predictive for future instrumentation.

CONCLUSIONS

Ultimately, the authors conclude that resection of SNSTs does not always necessitate fusion, and good outcomes can be obtained with motion-preserving techniques and minimizing facetectomy when possible. Patients with a history of NF2 and those with SNSTs that required ≥ 4-level laminectomy were more likely to exhibit some degree of structural abnormality and/or neurological deficit localized to the index level defined as either new or worsening spinal instability and/or new or worsening neurological deficit at last follow-up; however, no variable was found to be predictive of true spinal instability. Furthermore, a complete facetectomy at initial SNST resection and entirely extradural tumor location were noted to be associated with fusion at index surgery. Lastly, the authors were unable to identify a clinical predictor for future instrumentation.

ABBREVIATIONS

mRI = modified frailty index; NF1 = neurofibromatosis type 1; NF2 = NF type 2; SNST = spinal nerve sheath tumor.
  • Collapse
  • Expand

Surgical management of type II odontoid fractures. The upper left image shows cervicomedullary compression, a consequence of an untreated type II odontoid fracture. The upper right image demonstrates odontoid screw reduction and stabilization. The lower image shows a C1–2 Harms construct. Either option optimizes the canal diameter (red ring). Used with permission from Barrow Neurological Institute, Phoenix, Arizona. See the article by Avila et al. (pp 45–53).

  • 1

    Murovic JA, Cho Charles S, Park J. Surgical strategies for managing foraminal nerve sheath tumors: the emerging role of CyberKnife ablation. Eur Spine J. 2010;19(2):242256.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Halvorsen CM, Rønning P, Hald J, et al. The long-term outcome after resection of intraspinal nerve sheath tumors: report of 131 consecutive cases. Neurosurgery. 2015;77(4):585593.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Safaee M, Oh T, Barbaro NM, et al. Results of spinal fusion after spinal nerve sheath tumor resection. World Neurosurg. 2016;90:613.

  • 4

    Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M. Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors: an institutional experience and review of the current literature. J Neurosurg Spine. 2019;31(1):112122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Ahmad FU, Frenkel MB, Levi AD. Spinal stability after resection of nerve sheath tumors. J Neurosurg Sci. 2017;61(4):355364.

  • 6

    Camino-Willhuber G, Choi J, Holc F, et al. Utility of the modified 5-Items Frailty Index to predict complications and mortality after elective cervical, thoracic and lumbar posterior spine fusion surgery: multicentric analysis from ACS-NSQIP Database. Global Spine J. Published online September 1, 2022. doi:10.1177/21925682221124101

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Ito K, Aoyama T, Miyaoka Y, Seguchi T, Horiuchi T, Hongo K. Surgery for ventral intradural thoracic spinal tumors with a posterolateral transpedicular approach. Acta Neurochir (Wien). 2016;158(8):15631569.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Taleb FS, Guha A, Arnold PM, Fehlings MG, Massicotte EM. Surgical management of cervical spine manifestations of neurofibromatosis type 1: long-term clinical and radiological follow-up in 22 cases. J Neurosurg Spine. 2011;14(3):356366.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Weber MH, Burch S, Buckley J, et al. Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review. Int J Oncol. 2011;38(1):512.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg. 1982;57(4):441445.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Noh SH, Takahashi T, Inoue T, et al. Postoperative spinal deformity and instability after cervical spinal cord tumor resection in adults: a systematic review and meta-analysis. J Clin Neurosci. 2022;100:148154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Mautner VF, Tatagiba M, Lindenau M, et al. Spinal tumors in patients with neurofibromatosis type 2: MR imaging study of frequency, multiplicity, and variety. AJR Am J Roentgenol. 1995;165(4):951955.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Tamura R. Current understanding of neurofibromatosis type 1, 2, and schwannomatosis. Int J Mol Sci. 2021;22(11):5850.

  • 14

    Pichelmann MA, Atkinson JLD, Fode-Thomas NC, Yaszemski MJ. Total lumbar facetectomy without fusion: short and long term follow-up in a single surgeon series. Br J Neurosurg. 2017;31(5):531537.

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 767 767 29
Full Text Views 180 180 6
PDF Downloads 283 283 10
EPUB Downloads 0 0 0