Functional outcomes after surgery for intradural extramedullary spinal tumors: A retrospective study

Intradural extramedullary (IDEM) spinal tumors are predominantly benign lesions, and microsurgical excision remains the treatment of choice. Despite favorable outcomes reported in the literature, predictors of functional recovery remain clinically relevant, particularly in resource-limited settings.

We retrospectively reviewed 170 consecutive patients who underwent microsurgical excision of spinal IDEM tumors at a single tertiary care center over a 10-year period. Preoperative neurological status was assessed using Frankel grading, and pain was evaluated using the Denis pain scale (DPS). All tumors were approached through a posterior, facet-sparing technique. Functional outcomes were assessed postoperatively, at 2 weeks, and at 6 months. Factors influencing outcomes were analyzed using univariate statistical methods.

Gross total resection was achieved in 93% of patients. At final follow-up, 157 patients (92.4%) demonstrated a good functional outcome, including 84 (49.4%) patients with ≥2-grade improvement in Frankel score. Poor preoperative neurological status (Frankel A-C) and ventral axial tumor location were significantly associated with poorer outcomes (P = 0.010 and P = 0.026, respectively). Mean DPS scores improved significantly following surgery (P < 0.001). Postoperative complications were infrequent, and there was no operative mortality.

Microsurgical excision of IDEM tumors through a posterior, facet-sparing approach provides favorable neurological and pain outcomes with low morbidity. Preoperative neurological status and ventral tumor location are important predictors of postoperative recovery. Early surgical intervention remains critical for optimizing functional outcomes.