Posterior Para-middle Approach for Removal of Para-vertebral Schwannoma of the Lumbar Spine

XIE Jing-cheng, WANG Zhen-yu, MA Chang-cheng, LIU Bin and CHEN Xiao-dong. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, P.R.China.

【Abstract】Objective To evaluate the feasibility and relevant technique factors of posterior via para-middle approach for removal of papra-vertebral schwannoma of the lumbar spine. Methods The authors retrospectively analyzed a series of 3 patients para-vertebral tumors of lumbar spine surgically treated through para-middle approach from July 2010 to March 2011. There were 3 females with average age of 50.7 years. The patients present radicular neuralgia of lumbar spine in clinical. MRI reveals mixture signal with apparent enhancement. The tumors located at the L4-5 in 2cases and L2-3 in 1 case. Axial view showed the tumors located anterior to the transverse process and posterior to the psoas muscle. The surgical treatment under microscope included total resection of the tumors. Result 3 operations had been performed with gross total of tumor resection in all cases. There was no surgical complications happened. Clinically, the symptoms of radicular neuralgia prior operation were relieved. The histological examination showed Schwannoma in 3 cases. The period of follow-up was ranged from 3 months to 11 months. Clinically, there was 1 patient with pain surrounding the incision area that was disappeared 8 months post-operation. Neurological status had been stable during the followed-up. The recurrence rate was 0%. There was no unstability of lumbar spine was found during the follow-up. Conclusion The Schwannoma located at para-vertebral lumbar spine can be well revealed and removed through para-middle approach. This approach dictates minimally influence of spine stability.

【Keywords】 Spinal cord tumor; Schwannoma; Spine; Microsurgery