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  • Fusion Need for Spinal Instability after Facet Joint Surgical Resection for Spinal Peripheral Nerve Sheath Tumors (PNST): An Institutional Experience and Review of Current Literature

    Final Number:

    Mohammed Adeeb Sebai; Panagiotis Kerezoudis; Mohammed Ali Alvi MD; Robert J. Spinner MD; Mohamad Bydon MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Spinal peripheral nerve sheath tumors (PNSTs), including schwannomas and neurofibromas, are a group of tumors originating from the nerve and its supporting structures. Standard surgical management for spinal PNST can include facetectomy allowing adequate tumor resection. Fusion is occasionally performed to maintain spinal stabilization. Herein, we conducted a retrospective cohort study investigating the factors for performing fusion in patients with PNSTs undergoing facetectomy.

    Methods: We analyzed all patients surgically treated for a primary diagnosis of spinal PNST at a single tertiary referral center between 1995 and 2017. Variables of interest included age at the time of surgery, tumor size, tissue diagnosis, total operated levels, addition of fusion, and indication for fusion reported by the surgeon.

    Results: A total of 56 patients (52% females) fit inclusion criteria. Age and sex were evenly distributed among fusion and non-fusion groups for all patients who had facetectomy. The most common tumor was found to be schwannoma in both groups (75% in non-fusion group vs 85.7% in the fusion group, p= 0.50). Tumor size was found to be similar in both groups (27.56mm ± 13.44 in non-fusion vs 31.96 mm ± 14.68 in fusion group, p= 0.26). Total facetectomy for tumor resection, compared to subtotal facetectomy, was found to be associated with a possible higher risk of receiving immediate fusion (OR=6.16, 95% CI= 1.19-31.82, p=0.02). Cervicothoracic involvement was found in 10 patients and was also associated with an increased likelihood of immediate fusion (OR= 5.2, 95%CI=0.99-27.22, p=0.03).

    Conclusions: Study results indicate that patients with PNST requiring total facetectomy and having cervicothoracic involvement have a higher risk of receiving an immediate fusion. Future studies are needed to provide more insight regarding this topic.

    Patient Care: It will contribute to the specific knowledge of instability after spinal PNST removal preventing unnecessary financial burden and possible future complications of undue arthrodesis.

    Learning Objectives: • Fusion rate after adequate assessment of spinal PNST patients was seen to be around 50% with facetectomy. • Complete facetectomy and cervicothoracic area of involvement are important factors for considering arthrodesis. • Patient age, tumor size, and pre-exesting deformity had no effect on fusion need.


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