Minimally Invasive Surgical Experience Using Tubular Retraction for Intradural Extramedullary Spine Pathology: A Case Series and Systematic Review With Pooled Analysis

Objective: Research interest in minimally invasive spine surgery (MIS) is increasing; however, significant heterogeneity often exists among reported surgical techniques broadly classified as minimally invasive. High-quality data specifically addressing MIS techniques for intradural spinal pathology remain particularly scarce. Here, we present our experience, along with that of other groups, utilizing MIS techniques with an emphasis on tubular retraction for treating intradural extramedullary (IDEM) spinal pathology.Methods: Twenty-four patients with IDEM pathology were treated using MIS techniques, including tubular retraction, from 2006 to 2018. Additionally, a systematic literature review was conducted to enable a pooled analysis of patient demographics and perioperative outcomes.Results: In addition to our own patient series, 16 other case series were identified through systematic review. The resulting combined dataset from these 17 series included 323 patients available for pooled analysis. Nerve sheath tumors and meningiomas represented over 80% of the pathologies. Gross total resection was achieved in 93% of the pooled MIS IDEM cases. The mean estimated blood loss was 131 mL, the mean operative duration was 169 minutes, and the mean hospital stay was 4.1 days.Conclusion: MIS resection using tubular retraction is a safe and effective approach for managing IDEM pathology. Our pooled cohort provides valuable comparative data for assessing outcomes against open surgical techniques.