Derkach Y. The diagnosis and surgical treatment of tumors of spinal nerves from the cervical paravertebral distribution

The research is based on the analysis of the results of examination and treatment of 65 patients operated for spinal nerve tumors of the cervical spine with paravertebral spread in the period from 1998 to 2018. The observations are divided into two groups, which are different in terms of diagnostic research and treatment technologies: group 1 - 1998-2007, group II–2008-2018 years. Segmental sensory and segmental motor disorders, conduction disorders were observed in dynamics according to existing standards. The analysis of topographic and anatomical characteristics of spinal nerve tumors of the cervical region with paravertebral distribution revealed the following distribution of placement options: 18 (27.7%) cases of tumors were detected at the level of C1-C2 vertebrae, 27 (41.5%)–C2 - C3 vertebrae, 5 (7.7%)–C3 - C4 vertebrae, 3 (4.6%)–C4 - C5 vertebrae, 5 (7.7%)–C5 - C6 vertebrae, 7 (10.7%)–C6 - C7 vertebrae, 2 (3%)–C7 - tn1 vertebrae. Displacement of the common carotid artery by a tumor was diagnosed in the preoperative period in 12 % and in 24 % of the vertebral artery. In group II of the observation period, in addition to standard neuroimaging methods (MRI, MSCT), in the presence of changes in the location of the vertebral artery or the need for detailed visualization of the vertebral artery, the use of MSCT angiography, selective hypertension at the planning stage provides a clear justification for the choice of access and prevents the development of complications. The choice of surgical access for removal of tumors of spinal nerves of the cervical paravertebrally with the spread depends on the interplay of the main mass of tumor and the extent and direction of its paravertebral component relative to the plane of the spinal cord, dura and conditional physiological plane bending intervertebral foramen, which helped to develop and implement working topographic – anatomic classification. This approach optimizes the deletion stage to ensure that the deletion is radical. A comparative analysis of the I and II observation periods proved that total removal of the PSMN tumor of the cervical spine requires subsequent reliable fixation of the spine, primarily in cases of posterior and posterolateral accesses. It reduces the progression of kyphotic deformity of the cervical spine and the prevention of progrediency of neurological deficit in the long-term period of observation by 46.7%. The optimization of the diagnostic scheme for objectification of the first manifestations of neurocompression syndrome in PSMN and a differentiated approach to the choice of timing and method of surgical treatment provided a reduction (38.7 ± 1.1 months in the period, 18.5 ± 1, 3 months in the second period of the study) of neurological deficit. The interconnection research between the duration of anamnesis and the probability on the McCormick scale of transition to another group (improvement of the condition and regression of neurological disorders) after surgery showed that the longer the history, the less likely the transition to another group. The use of a differential approach to the choice of surgical access for the removal of cervical spinal nerve tumors with paravertebral spread provides high quality of life indicators. Patients in the II group of observations had a satisfactory condition (0 point according to ECOG scale) in the early and long-term postoperative period than 1 group patients.