Objective To investigate the clinical classification and microsurgical treatment strategies of spinal dumbbell tumors. Methods From January 2008 to December 2014, the clinical manifestations and imaging features of 124 patients with intra-and extra-spinal tumors resected by microsurgery at the Department of Neurosurgery, Tianjin Medical University General Hospital were analyzed retrospectively.Four-zone tumor typing methodwas established to guide the choice of surgical approaches. Fifty-three patients were treated via the simple posterior midline laminectomy approach, 47 via the semi-laminectomy approach, 11 via the combined anterior and posterior approach, 8 via the lateral cervical approach, and 5 via the far lateral approach, in which 89 patients were treated with stage 1 spinal internal fixation or laminoplasty. Results In 124 patients with intra-and extra-spinal tumors, 121 were removed totally, 2 were removed near totally, and 1 was removed partially. Postoperative pathology suggested that 77 patients had neurilemmoma, 15 had neurofibroma, 11 had angiolipoma, 8 had lymphoma, 5 had angioma, 3 had meningioma, 3 had ganglioneuroma, 1 had cavernous hemangioma, and 1 small cell malignant tumor. The main bodies of the cervical tumors were located in the C area in 31 cases, in CB area in 8 cases, in CD area in 13 cases, in CBA area in 6 cases, in CDA area in 3 cases, in CABD area in 1 case, and the thoracic and lumbar tumors were located in C area in 62 cases. No surgical infection, cerebrospinal fluid leakage, and paraplegia patients were observed. They were followed up for 6 months to 3 years after procedure(mean 32.6+ 4.8 months). Postoperative limb motor function and sensory disturbance were improved significantly in 88 cases. There were no significant changes in 6 cases. The patients with new tumor after operation or regional expansion of sensory disturbance were in 3 cases. Conclusions The clinical classification of spinal dumbbell tumors has an important guiding significance for the selection of operative approaches. According to the classification of tumors, using the corresponding operation method may conduct tumor stage 1 total resection. Patients with bone destruction or intraoperative resection of small joints should perform spinal fixation simultaneously in order to maintain the stability of spines. Key words: Spinal cord neoplasms; Spine; Microsurgery