Objective: To compare the safety and outcomes between keyhole surgery and total
laminectomy for resection of intradural extramedullary
spinal cord tumors. Methods: Retrospectively collected the clinical data of 102 patients with intradural extramedullary
spinal cord tumors(≤3 cm) treated by surgery in Department of Orthopedics in Fujian Provincial Hospital from January 2014 to January 2017. Fifty cases underwent the keyhole surgery and the other 52 received total
laminectomy. The operation time, volume of intraoperative
bleeding, the leaving bed time, the length of postoperative
hospital stay, drainage, postoperative
complications, intraoperative neuroelectrophysiological monitoring (IONM), preoperative and postoperative visual analogue score (VAS), neck disability index (NDI), Oswestry disability index (ODI), McCormick spinal cord function grading were analyzed and compared between the two groups to evaluate the safety and clinical outcomes. The data of two groups were compared by t, χ(2) or rank sum test. Results: The keyhole group was followed up for (30±15) months and the total
laminectomy group was followed up for (45±15) months. All the
tumors were completely resected. All the incision healed well and no
cerebrospinal fluid leakage occurred. There was no statistically significant differences in baseline data, operation time, the results of IONM, preoperative and 3 months, 6 months, 12 months postoperative VAS, NDI (cervical
tumors), ODI (thoracic and lumbar
tumors), McCormick spinal cord function grading,
tumor recurrence between the two groups (all P>0.05). The keyhole group had less intraoperative
bleeding than that in the total
laminectomy group ((73±24) ml vs (136±26) ml, t=-12.610, P<0.05), earlier postoperative leaving bed time ((1.4±0.6) d vs (6.5±1.0) d, t=-31.822, P<0.05), and the postoperative
hospital stay was shorter ((4.3±0.8) d vs (11.2±2.0) d, t=-22.319, P<0.05), and it was more advantageous in terms of drainage. The VAS, NDI and ODI in the keyhole group improved significantly compared with those in the total
laminectomy group 2 weeks post operation (all P<0.05). Conclusion: Compared with the total
laminectomy, keyhole surgery is suitable for the treatment of intradural extramedullary
spinal cord tumors with small size and limited location, and it is equivalently safe with faster functional recovery.