Surgical strategy for intra- and extra-vertebral dumbbell-shaped tumors

Abstract

Objective To investigate the clinical features and surgical strategy of intra- and extra-vertebral dumbbell-shaped tumors. Methods Clinical data of 39 patients with intra- and extra-vertebral tumor were retrospectively studied. The tumors were removed via posterior midline approach in 33 patients, and via posterior combined with anterior approach in 6 patients. Thirty patients underwent tumor resection and internal fixation. Lateral mass screw fixation was performed in the level of C3-7, while the pedicular screw fixation was performed in the level of C2 and thoracic and lumbar segment. Results Tumors were totally excised in all the cases. The patients were followed-up for 6 months to 5 years with an average of 18.67 months. Pain relief occured in 29 cases, of whom the average Visual Analogue Scale (VAS) score decreased from (7.51 ± 1.05) before surgery to (3.17 ± 1.17) 24 h after surgery (P < 0.05). The numbness area emerged or enlarged in 12 cases and was unchanged in 3 cases. The average American Spinal Injury Association (ASIA) sensation score decreased from (218.67 ± 2.80) before surgery to (213.33 ± 2.16) 24 h after surgery (P < 0.05), but it increased to (216.78 ± 1.47) 6 months after operation (P < 0.05). The motor function improved in 18 cases, and ASIA motor function score improved from (92.33 ± 1.63) before surgery to (95.05 ± 1.41) 6 months after operation (P < 0.05). No tumor recurrence and secondary spinal deformity were found. Conclusion Most cases of dumbbell-shaped intra- and extra-vertebral tumor can be totally removed with one-session microsurgery. In the cases with bony erosion caused by tumor and facetectomy, concurrent internal fixation and fusion were recommended in order to maintain spinal stability. doi：10.3969/j.issn.1672-6731.2013.12.003 Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n12a3