Introduction: Intradural extramedullary spine tumors represent two-thirds of all primary spinal neoplasms. Approximately half are peripheral nerve sheath tumors, mainly schwannomas and neurofibromas. Given the rarity of this disease, analyses of spinal fusion outcomes are limited.
Methods: Age, gender, clinical presentation, presence of neurofibromatosis, tumor type, location, extent of resection characterized as gross total resection (GTR) or subtotal resection (STR), use of spinal fusion, and clinical follow-up were recorded.
Results: 221 tumors in 199 patients were identified with a mean age of 45 years. 53 were neurofibromas, 163 schwannomas, and 5 malignant peripheral nerve sheath tumors. 79 patients underwent fusion procedures, with 71 instrumented and 8 non-instrumented. The mean number of levels fused was 4, with a range of 2-10. Fusion locations were 39 cervical (49%), 19 thoracic (24%), and 21 lumbosacral (27%). Fusion procedures were more common for extradural tumors that required more extensive exposure and resection (60%) compared to intradural (43%) and paraspinal (27%) lesions (p=0.001). There was a trend towards higher fusion rates in neurofibromas compared to schwannomas (43% vs. 33%, p=0.18), likely due to a higher predilection of cervical and extradural lesions. The rate of wound infection (1% in fusion vs. 6% in non-fused) and CSF leak (5% in fusion vs. 4% in non-fused) were not statistically different. There were 10 fusion complications: 5 adjacent segment disease, 4 hardware failures, and 1 pseudoarthrosis that occurred at an average of 23 months. The mean time from surgery to last follow-up was 32 months.
Conclusions: In this cohort, neurofibromas required fusion procedures more often than schwannomas, likely due to higher rates of cervical and extradural lesions. Fusion was not associated with a higher rate of infection or CSF leak. The most common complication was adjacent segment disease, however all were asymptomatic and none required reoperation.
Patient Care: Expand our understanding of outcomes and complications of spinal fusion for nerve sheath tumor surgery.
Learning Objectives: By the conclusion of this session, participants should be able to 1) recognize utility of fusion for spinal peripheral nerve sheath tumors, 2) recognize association between tumor pathology/location and need for fusion, 3) recognize most common complications of fusion.