Surgical management and functional outcomes of intradural extramedullary spinal tumors: A single-center retrospective study.

Abstract

Background: Intradural extramedullary (IDEM) spinal tumors are the most common intradural spinal neoplasms, typically benign and slow-growing. They cause neurological deficits through progressive spinal cord compression. Surgical excision remains the mainstay of treatment, with generally favorable outcomes.

Objective: To analyse the clinical profile, surgical management, and functional outcomes of patients with IDEM spinal tumors.

Materials and methods: A retrospective study was conducted on 214 patients who underwent microsurgical excision of IDEM tumors between January 2009 and December 2023. Clinical presentation, radiological findings, surgical details, histopathology, complications, and functional outcomes were evaluated. Neurological status was assessed using the Modified McCormick Scale and American Spinal Injury Association impairment scale with a minimum follow-up of 12 months.

Results: The majority of patients were >45 years (40.2%) with a slight female predominance (54.7%). Back pain (80.4%) was the most common presenting symptom, followed by motor deficit (60.3%). The thoracic spine was most frequently involved (45.3%). Gross total resection was achieved in 83.6% of cases. Schwannoma (47.2%) and meningioma (30.8%) were the most common histologies. Mean blood loss and operative time were 172 ± 62 ml and 164 ± 43 min, respectively. Complications were low, with cerebrospinal fluid leak (2.8%) and wound infection (3.3%) being the most frequent. Significant postoperative neurological improvement was observed, with most patients achieving Modified McCormick Grade 1-2 at 2-year follow-up.

Conclusion: IDEM tumors have a favorable prognosis when managed surgically. Microsurgical excision allows high rates of complete resection with low morbidity. Early intervention is associated with better neurological recovery.