Posterior one-stage resection for intra- and extra-dumbbell-shaped tumor of the lumbar spine

Abstract

Objective To investigate the surgical technique and to evaluate the outcome of one stage resection for intra - and extra - dumbbell - shaped tumor of the lumbar spine.Methods 10 patients with dumbbell - shaped tumors of lumbar spine from 2006 to 2011treated surgically were analyzed retrospectively.The tumor located at the level of L4-5 in 6 cases,L2-3 in 3 cases and L5 - S1in 1case.Back pain and radicular neuralgia along the affected nerve root were the main clinical manifestation.There were three surgical approaches according to the main location of the tumors included para - middle approach through exra - par in 3 cases,posterior laminectomy in 4 cases,and posterior laminectomy and facetactomy plus instrumentation and fusion in 3 cases respectively.Results 10 operations had been performed with gross total of tumor resection in all cases.The timing of procedures was from 1.5 to 4.1hours.The volume of bleeding during operation was around 90 to 300 ml.There was no surgical complications happened.Clinically,the symptoms of back pain and radicular neuralgia prior to operation were relieved or disappeared.The histological examination showed Schwannoma in 9 cases,and neurofibroma in 1case.The period of follow - up was ranged from 3 months to 5 years.There was 1patient with pain surrounding the incision area happened in 2 months post - operation and that was disappeared 8 months post - operation.Neurological status had been stable during the followed - up period. The recurrence rate was 0. The alignment and lordosis of lumbar spine was intact during the follow - up.Conclusions The Schwannoma and neurofibroma were the most common pathological type of dumbbell - shaped tumor located at the lumbar spine and that can be well revealed and removed through appropriate approaches according to the pre operation MRI manifestation. Key words: Spinal cord neoplasms; Schwannoma; Spine; Microsurgery