COMBINED POSTERIOR AND ANTERIOR APPROACHES FOR RESECTION OF THORACOLUMBAR SPINAL HUGE DUMBBELL-SHAPED TUMOR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHIJiandang ¹ , ZHAOChen ² ^Δ , DINGHuiqiang ¹ , FUBin ¹ , NIUNingkui ¹ , YUEXuefeng ² , YANGZongqiang ² , HEYin ²

1. Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P. R. China;
2. Graduate School, Ningxia Medical University;

Corresponding author：

SHIJiandang, Email: shi_jiandang@163.com

Keywords：

Thoracolumbar spine; Intra- and extra-spinal canal; Dumbbell-shaped tumor; Combined anterior and posterior approaches

DOI：

10.7507/1002-1892.20160038

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Objective To investigate the surgical outcome of combined posterior and anterior approaches for the resection of thoracolumbar spinal canal huge dumbbell-shaped tumor. Methods Between January 2009 and March 2015, 12 patients with thoracolumbar spinal canal huge dumbbell-shaped tumor were treated by posterior approach and anterolateral approach through diaphragmatic crura and thoracoabdominal incision for complete resection. There were 9 males and 3 females, with an average age of 45 years (range, 30-65 years). The disease duration was 8-64 weeks (mean, 12.7 weeks). The tumor was located at T₁₂, L₁ in 6 cases, at L_{1, 2} in 5 cases, and at L_{2, 3} in 1 case. The tumor size ranged from 4.3 cm×4.0 cm×3.5 cm to 7.5 cm×6.3 cm×6.0 cm. According to tumor outside the spinal involvement scope and site and based on the typing of Eden, 5 cases were rated as type b, 2 cases as type d, 4 cases as type e, and 1 case as type f in the transverse direction; two segments were involved in 8 cases, and more than two segments in 4 cases. The degree of tumor excision, tumor recurrence, and the spine stability were observed during follow-up. The verbal rating scale (VRS) was used to evaluate pain improvement. Results The average surgical time was 170 minutes (range, 150- 230 minutes); the average intraoperative blood loss was 350 mL (range, 270-600 mL). All incisions healed by first intention, and no thoracic cavity infection and other operation related complication occurred. Of 12 cases, 10 were histologically confirmed as schwannoma, and 2 as neurofibroma. The patients were followed up 6 months to 6 years (mean, 31 months). Neurological symptoms were significantly improved in all patients, without lower back soreness. The thoracolumbar X-ray film and MRI showed no tumor residue. No tumor recurrence, internal fixator loosening, scoliosis, and other complications were observed during follow-up. VRS at last follow-up was significantly improved to grade 0 (10 cases) or grade I (2 cases ) from preoperative grade I (2 cases), grade II (8 cases), and grade III (2 cases) (Z= —3.217, P=0.001). Conclusion Combined posterior approach and anterolateral approach through diaphragmatic crura and thoracoabdominal incision for complete resection of thoracolumbar spinal canal huge dumbbell-shaped tumor is feasible and safe, and can protect the stability of thoracolumbar spine and paraspinal muscle function. It can obtain satisfactory clinical result to use this method for treating the complex type of thoracolumbar spinal canal dumbbell-shaped tumor.

Citation： SHIJiandang, ZHAOChen, DINGHuiqiang, FUBin, NIUNingkui, YUEXuefeng, YANGZongqiang, HEYin. COMBINED POSTERIOR AND ANTERIOR APPROACHES FOR RESECTION OF THORACOLUMBAR SPINAL HUGE DUMBBELL-SHAPED TUMOR. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 183-188. doi: 10.7507/1002-1892.20160038 Copy

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2.	Agrawal A, Cincu R, Wani B. Modified posterior unilateral laminectomy for a complex dumbbell schwannoma of the thoracolumbar junction. Acta Orthop Traumatol Turc, 2009, 43(6):535-539.
3.	龙厚清, 黄荷, 谢文翰, 等. Ⅰ期后入路手术切除胸椎神经源性哑铃型肿瘤的解剖学及其疗效. 中国临床解剖学杂志, 2013, 31(5):586-590.
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7.	Jinnai T, Koyama T. Clinical characteristics of spinal nerve sheath tumors:analysis of 149 cases. Neurosurgery, 2005, 56(3):510-515.
8.	An HS, Lim TH, You JW, et al. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine (Phila Pa 1976), 1995, 20(6S):1979-1983.
9.	McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery, 1996, 38(1):67-74.
10.	陈志, 冯华, 林江凯, 等. 胸椎管哑铃形神经鞘瘤切除后复发1例报告. 中国脊柱脊髓杂志, 2005, 15(2):127-128.
11.	Oda I, Abumi K, Lü D, et al. Biomechanical role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine. Spine (Phila Pa 1976), 1996, 21(12):1423-1429.
12.	陈宣煌, 许卫红, 胡建伟, 等. 小切口椎旁肌间隙入路和传统开放式入路腰椎后路融合术的比较. 脊柱外科杂志, 2012, 10(2):101-104.
13.	Konno S, Yabuki S, Kinoshita T, et al. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine (Phila Pa 1976), 2001, 26(6):E130-134.
14.	Khoo LT, Rudolf B, Michael P. Thoracoscopic-assisted treatment of thoracic and lumbar fractures:a series of 371 consecutive cases. Neurosurgery, 2002, 51(5):S104-117.
15.	Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance:experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1):33-39.
16.	McGirt MJ, Garcés-Ambrossi GL, Parker SL, et al. Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors:analysis of 238 patients. Neurosurgery, 2010, 66(5):1005-1012.
17.	Kim DH, Jahng TA, Balabhadra RS, et al. Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine J, 2004, 4(3):317-328.
18.	刘端, 杜心如, 孔祥玉. 膈肌脚在上腰椎爆裂骨折手术中复位作用的解剖研究. 中国临床解剖学杂志, 2014, 32(4):400-404.

1. Ozawa H, Kokubun S, Aizawa T, et al. Spinal dumbbell tumors:an analysis of a series of 118 cases. J Neurosurg Spine, 2007, 7(6):587-593.
2. Agrawal A, Cincu R, Wani B. Modified posterior unilateral laminectomy for a complex dumbbell schwannoma of the thoracolumbar junction. Acta Orthop Traumatol Turc, 2009, 43(6):535-539.
3. 龙厚清, 黄荷, 谢文翰, 等. Ⅰ期后入路手术切除胸椎神经源性哑铃型肿瘤的解剖学及其疗效. 中国临床解剖学杂志, 2013, 31(5):586-590.
4. Eden K. The dumb-bell tumours of the spine. Br J Surg, 1941, 28(112):549-570.
5. 谭冠先. 疼痛诊疗学. 北京:人民卫生出版社, 2001:4-6.
6. Suzuki A, Nakamura H, Konishi S, et al. Dumbbell-shaped meningioma with cystic degeneration in the thoracic spine:a case report. Spine (Phila Pa 1976), 2002, 27(7):E193-196.
7. Jinnai T, Koyama T. Clinical characteristics of spinal nerve sheath tumors:analysis of 149 cases. Neurosurgery, 2005, 56(3):510-515.
8. An HS, Lim TH, You JW, et al. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine (Phila Pa 1976), 1995, 20(6S):1979-1983.
9. McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery, 1996, 38(1):67-74.
10. 陈志, 冯华, 林江凯, 等. 胸椎管哑铃形神经鞘瘤切除后复发1例报告. 中国脊柱脊髓杂志, 2005, 15(2):127-128.
11. Oda I, Abumi K, Lü D, et al. Biomechanical role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine. Spine (Phila Pa 1976), 1996, 21(12):1423-1429.
12. 陈宣煌, 许卫红, 胡建伟, 等. 小切口椎旁肌间隙入路和传统开放式入路腰椎后路融合术的比较. 脊柱外科杂志, 2012, 10(2):101-104.
13. Konno S, Yabuki S, Kinoshita T, et al. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine (Phila Pa 1976), 2001, 26(6):E130-134.
14. Khoo LT, Rudolf B, Michael P. Thoracoscopic-assisted treatment of thoracic and lumbar fractures:a series of 371 consecutive cases. Neurosurgery, 2002, 51(5):S104-117.
15. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance:experience in a large patient cohort. J Neurosurg Spine, 2009, 10(1):33-39.
16. McGirt MJ, Garcés-Ambrossi GL, Parker SL, et al. Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors:analysis of 238 patients. Neurosurgery, 2010, 66(5):1005-1012.
17. Kim DH, Jahng TA, Balabhadra RS, et al. Thoracoscopic transdiaphragmatic approach to thoracolumbar junction fractures. Spine J, 2004, 4(3):317-328.
18. 刘端, 杜心如, 孔祥玉. 膈肌脚在上腰椎爆裂骨折手术中复位作用的解剖研究. 中国临床解剖学杂志, 2014, 32(4):400-404.

Chinese Journal of Reparative and Reconstructive Surgery

COMBINED POSTERIOR AND ANTERIOR APPROACHES FOR RESECTION OF THORACOLUMBAR SPINAL HUGE DUMBBELL-SHAPED TUMOR

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