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The journal Operative Neurosurgery recently published a paper by Dr. James K. C. Liu, a neurosurgeon in the Neuro-Oncology Program at Moffitt Cancer Center, on the use of minimally invasive techniques to resect paraspinal tumors, titled Paramedian Wiltse Approach for Giant Paraspinal Lumbar Schwannoma: Technical Note and Alternative Approaches. The primary objective of this paper was to highlight the use of a muscle-sparing approach to resect large paraspinal schwannomas.

Schwannomas are benign tumors that arise from Schwann cells that surround peripheral nerves. These are typically slow-growing tumors that do not spread to other parts of the body, but they can grow large enough to press on adjacent neural structures, which can lead to symptoms. Schwannomas from nerves near the spine are most common in adults between ages 40 and 70, although they can occur at any age. The most ideal treatment usually involves surgical resection.

The most traditional approach to spine tumors is through a posterior midline approach. However, for schwannomas that grow next to the spine in a paraspinal location, a midline approach may result in suboptimal exposure requiring extensive bony removal and destabilization of the spine. Alternative approaches, including paramedian, lateral, and anterior approaches, may provide more direct access to the paraspinal region.   

Katie was young and active so she was confused when she started experiencing chronic back pain. A full range of testing revealed that Katie had a large tumor on the lower right-hand side of her back. The diagnosis was schwannoma

"Dr. Liu performed a paraspinal lumbar surgery using specialized retractors through a small incision. He was able to reach the tumor with minimal disruption of the spinal muscles and without the need to remove any bone from the spine,"  said Katie.

Four years later, Katie is fully recovered and still marvels at how quickly her back pain subsided.

These approaches have become more popular with the advancement of minimally invasive techniques which allow for minimal bone removal to avoid postoperative instability. Key benefits of minimally invasive techniques include smaller incisions, minimal blood loss, shorter recovery time, and enhanced quality of life with minimal disruption of systemic or radiation therapies.

The sacrospinalis muscle splitting approach, or Wiltse approach, allows direct access to the paraspinal space without destabilization of the spine. Using the Wiltse approach, along with expandable retractor systems, can provide adequate exposure to allow for complete resection of giant paraspinal schwannomas and potential neural preservation, without the need for destabilization of the spine.

At Moffitt, we consider it a privilege to partner with referring providers to care for our shared patients. After surgery, we can arrange for the patient to receive treatment within his or her local community if desired. We also provide a second opinion consult on a full range of complex neurologic cancers and conditions in a single, convenient location. 

To learn more about Moffitt’s MISO program or to discuss a specific patient, please contact your physician liaison to set up a virtual meeting with Dr. Liu. Or, if you’d like to refer a patient to Moffitt, complete our online form or contact a physician liaison for assistance. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.