ArticleSpinal cord2025
How many cases of spinal intramedullary ependymoma surgery are required to achieve stability? - Analysis using X-bar charts.
Article in Spinal cord, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Global trends in scientific production on physical exercise and spinal cord injury.Frontiers in sports and active living · 2025Review
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
designRetrospective cohort study.
objectivesTo evaluate surgical consistency and clinical outcomes in intramedullary ependymoma (WHO grade II) cases by using X-bar charts as a tool to assess procedural stability.
settingThe single institution in Japan.
methodsThis study included patients who underwent resection of intramedullary ependymomas between 2001 and 2023. All surgeries were performed by one of five board-certified spine surgeons. Operative time was analyzed for stability using X-bar charts. Neurological outcomes were assessed using the modified McCormick Scale (mMS), and regression analysis was performed to evaluate the relationship between operative time and mMS.
resultsThe study included 144 patients (82 men, 62 women; average age 50.3 ± 14.6 years). Tumors were located at cervical (67.4%) or thoracic (32.6%) levels, averaging 3.0 ± 1.2 vertebrae. The surgeon who performed 71 cases was defined as the experienced surgeon, and the other surgeons performed 10-24 cases, respectively. The mean operative time was 380.6 ± 140.7 min, and 135 cases achieved gross total resection. The average follow-up duration was 6.9 ± 3.9 years. X-bar charts showed surgical stability once the average number of cases exceeded 17. No significant correlation was found between operative time and mMS for any surgeon. Perioperative complications were minimal.
conclusionsX-bar charts are a valuable tool for objectively evaluating surgical stability. In intramedullary ependymoma surgeries, consistency in operative time was achieved after 17 cases, and longer procedures did not adversely affect neurological outcomes. This method could be extended to monitor procedural reliability in other complex surgical interventions.
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