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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 840-850. doi: 10.19723/j.issn.1671-167X.2019.05.009

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Comparative clinical study on seldom segment with multiple segment intramedullary primary spinal cord tumors

Jian-jun SUN1,△(),Jun YANG1,Jing-cheng XIE1,Qing CHANG2,Chang-cheng MA1,Mei ZHENG3,Hung-I LIAO4,Tao WANG1,Xiao-dong CHEN1,Yun-feng HAN1,Guo-zhong LIN1,Tao YU1,Jia ZHANG1,Yu SI1   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
    4. Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
  • Received:2018-01-27 Online:2019-10-18 Published:2019-10-23
  • Contact: Jian-jun SUN E-mail:15611963113@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81200969/H0912);the Grants from Science Foundation for the Excellent Youth Scholars of Ministry of Education of China(200800011035)

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Abstract:

Objective: Several clinical studies were performed on multi-segment intramedullary primary spinal cord tumors. However, no clinical study focused on the relationship between different vertebral segments intramedullary tumors involvement and neurological functions, as well as prognosis of the patients. This prospective study was performed to compare clinical analysis on neurological functions and prognosis of the patients with intramedullary spinal cord primary tumors. Methods: A prospective cohort study was performed in a single medical center, Neurosurgical Department, Peking University Third Hospital. Between Jan. 1, 2010 and Dec. 30, 2015, 135 patients underwent microsurgery for intramedullary primary spinal cord tumors. The intramedullary tumor length occupying 3 or more vertebral body levels was considered as multiple segments intramedullary primary spinal cord tumor, and occupying one or two vertebral body levels considered as seldom segments. Preoperative and postoperative functions were assessed using IJOA (improved Japanese orthopaedic association) scoring system, and analyzed using the appropriate statistical tests. Results: Among the 135 patients, 52 cases had seldom segments intramedullary primary spinal cord tumors, and 83 cases had multiple segments. In the seldom group, 32 (62%) patients presented with normal urine and stool function, 8 (15%) patients with severe dysfunction, 7 (14%) with slight dysfunction, and 5 (9%) with incontinence, and 30 (58%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 16.9±2.4. The postoperative IJOA scores at the end of 3 months were 16.6±2.3. The current IJOA scores until the end of the follow-up were 17.5±4.4. In the multiple group, 37 (45%) patients presented with normal urine and stool functions, 26 (31%) patients with slight dysfunction, 11 (13%) with severe dysfunction, and 9 (11%) with incontinence, and 62 (75%) patients demonstrated various degrees of limbs weakness. The preoperative IJOA scores of the patients were 15.6±3.4. The postoperative IJOA scores at the end of 3 months were 15.5±3.8. The current IJOA scores until the end of the follow-up were 16.9±5.8. The difference of presenting urine and stool dysfunction (Z=-1.35, P=0.18) was not statistically significant between the different patient groups. However, the difference of presenting limbs weakness (Z=-2.06, P=0.04) was statistically significant between the two groups. Most patients with multiple segment intramedullary tumors suffered from various limbs weakness. The difference of the preoperative IJOA score (P=0.02) and the postoperative early IJOA score (P=0.004) of the patients was statistically significant between the seldom and multiple segments groups. Preoperative and early postoperative neurological function of the patients was better with seldom segments tumor than with multiple segments tumor. Most patients with multi-segment intramedullary tumors experienced various limbs weakness. However, the difference of long-term neurological function (P=0.12) between the seldom and multiple segments groups was not statistically significant. The neurological function of the patients with multiple segments intramedullary tumor was remarkably improved after physical therapy. Conclusion: Perioperative neurological function of the patients with seldom segments primary tumor was superior to that of the patients with multiple segments primary tumor, especially for limb strength. The neurological function of the patients with multiple segments intramedullary primary tumor was remarkably improved after physical therapy during long-term follow-up.

Key words: Intramedullary primary tumor, Seldom segments, Multiple segments, Pathology, Neurological functions, Prognosis

CLC Number: 

  • R739.42

"

Items Different groups All patients t value P value
Seldom Multiple
Age/years 40±15 40±14 40±14 0.31 0.76
Occupied numbers 1.8±0.4 4.2±1.8 3.3±1.8 34.3 <0.001
Hospitalization time/d 16.4±2.5 17.9±6.2 16.5±4.8 -1.22 0.23
Duration of symptoms/months 22±29 47±77 37±64 11.9 0.001
Preoperative IJOA scores 16.9±2.4 15.6±3.5 16.1±3.2 6.13 0.02
Three months postoperative IJOA scores 16.6±2.4 15.5±3.8 15.9±3.4 8.53 0.004
Current IJOA scores 17.5±4.5 16.9±5.9 17.1±5.3 2.38 0.12
Longer meter of tumors/cm 2.8±1.6 8.3±5.07 6.2±4.9 11.1 0.001
Follow-up period/months 42±17 40±21 43±19
Case numbers 52 83 135

"

Items Different groups All patients Z value P value
Seldom Multiple
Gender -0.15 0.88
Male 27 (52%) 42 (51%) 69 (51%)
Female 25 (48%) 41 (49%) 66 (49%)
Presenting symptoms -1.04 0.30
Pain 18 (35%) 35 (42%) 53 (39%)
Numbness 12 (23%) 18 (22%) 30 (22%)
Limbs weakness 10 (19%) 13 (16%) 23 (17%)
Neck or limbs discomfort 7 (13%) 3 (4%) 10 (8%)
Urine and/or stool dysfunction 3 (6%) 4 (5%) 7 (5.2%)
Numbness and weakness 2 (4%) 7 (8%) 9 (6.7%)
Dyspnea 0 1 (1%) 1 (0.7%)
Dizziness 0 1 (1%) 1 (0.7%)
Limbs malformation 0 1 (1%) 1 (0.7%)
Preoperative bowel/bladder -1.35 0.18
Normal 32 (62%) 37 (45%) 69 (51%)
Slight dysfunction 7 (14%) 26 (31%) 33 (25%)
Severe dysfunction 8 (15%) 11 (13%) 19 (14%)
Incontinent 5 (9%) 9 (11%) 14 (10%)
Preoperative motor weakness -2.06 0.04
Normal 22 (42%) 21 (25%) 43 (32%)
Weakness 30 (58%) 62 (75%) 92 (68%)
Location -1.57 0.12
Cervical 15 (29%) 30 (36%) 45 (33%)
Thoracic 17 (33%) 19 (23%) 36 (27%)
Cervicothoracic 2 (4%) 11 (13%) 13 (10%)
Thoracolumbar 6 (11%) 12 (15%) 18 (13%)
Lumbar 11 (21%) 9 (11%) 20 (15%)
Medulla-cervical 1 (2%) 2 (2%) 3 (2%)
Removal extent -1.72 0.09
Class Ⅰ 39 (75%) 52 (63%) 91 (67.4%)
Class Ⅱ 8 (15%) 14 (17%) 22 (16.3%)
Class Ⅲ 5 (10%) 11 (13%) 16 (11.9%)
Class Ⅳ 0 6 (7%) 6 (4.4%)
Histological pathology -3.12 <0.01
Vascular tumors 16 (31%) 0 16 (12%)
Ependymoma 14 (27%) 40 (48%) 54 (40%)
Teratoma 6 (11%) 15 (18%) 21 (16%)
Lipoma 0 7 (8%) 7 (5%)
Diffuse astrocytoma 5 (9%) 7 (8%) 12 (9%)
High-grade gliomas 4 (8%) 5 (6%) 9 (7%)
Cyst 4 (8%) 4 (5%) 8 (6%)
Low-grade gliomas 3 (6%) 3 (4%) 6 (4%)
Schwannoma 0 2 (3%) 2 (1%)

"

Items Different groups F value P value
Survival Dead
Age/years 40.8±13.6 38.0±23.7 8.7 0.004
Hospitalization/d 15.9±3.1 23.6±14.1 35.0 <0.001
Preoperative IJOA scores 16.5±2.8 13.3±4.3 -3.1 0.003
Three months postoperative IJOA scores 16.5±3.0 12.9±5.1 9.0 0.003
Current IJOA scores 18.3±2.7 0 6.1 0.020
Case number 110 8

"

Items Different groups All patients Z value P value
Survived Dead
Recurrence of tumors -5.37 <0.001
Yes 7 (6%) 6 (75%) 13 (11%)
No 103 (94%) 2 (25%) 105 (89%)
Removal extent -5.16 <0.001
Class Ⅰ 82 (75%) 1 (12.5%) 83 (70%)
Class Ⅱ 17 (15%) 1 (12.5%) 18 (15%)
Class Ⅲ 11 (10%) 4 (50%) 15 (13%)
Class Ⅳ 0 2 (25%) 2 (2%)
Histological pathology -4.63 <0.001
Ependymoma 50 (45%) 0 50 (42%)
Teratoma 20 (18%) 0 20 (17%)
Vascular tumor 13 (12%) 1 (12.5%) 14 (13%)
Diffuse astrocytoma 8 (7%) 2 (25%) 9 (8%)
High-grade gliomas 2 (2%) 4 (50%) 6 (5%)
Low-grade glioma 4 (4%) 1 (12.5%) 5 (4%)
Lipoma 6 (5.5%) 0 6 (5%)
Neuronoma 2 (2%) 0 2 (2%)
Cyst 5 (4.5%) 0 5 (4%)

"

Items Different groups t value P value
Recurrence or regrowth Locally controlled
Age/years 33.1±19.8 45.3±12.6 -2.68 0.009
Duration of symptoms /months 6.3±6.5 39.0±65.9 5.8 0.020
Hospitalization/ d 21.4±11.4 15.8±3.1 19.3 <0.001
Current IJOA scores 7.0±7.8 18.4±3.3 33.4 <0.001
Three months postoperative IJOA scores 12.7±4.9 16.7±2.8 19.4 <0.001
Case number 105 13

"

Items Different groups All patients Z value P value
Recurrence or regrowth Local control
Removal extent -5.64 <0.001
Class Ⅰ 1 (7%) 82 (78%) 83 (70%)
Class Ⅱ 4 (31%) 14 (13%) 18 (15%)
Class Ⅲ 6 (47%) 9 (9%) 15 (13%)
Class Ⅳ 2 (15%) 0 2 (2%)
Histological pathology -2.35 0.02
Ependymoma 2 (15%) 48 (45%) 50 (42%)
Teranoma 2 (15%) 18 (17%) 20 (17%)
Diffuse astrocytoma 3 (24%) 6 (6%) 9 (8%)
High-grade glioma 5 (39%) 2 (2%) 7 (6%)
Low-grade glioma 1 (7%) 4 (4%) 5 (4%)
Lipoma 0 6 (6%) 6 (5%)
Vascular tumors 0 14 (13%) 14 (12%)
Neuronoma 0 2 (2%) 2 (2%)
Cyst 0 5 (5%) 5 (4%)
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