Microsurgical management of dumbbell-shaped tumors of the vertebral canal

Objective To summarize the experience in microsurgically resecting dumbbell-shaped tumors of the vertebral canal and preserving spinal stability.Methods Twenty-two patients with dumbbell-shaped tumors of the vertebral canal underwent microsurgical resection during May 2004 to July 2006.Sixteen cervical tumors were resected via modified far lateral approach(posterior lateral intermuscular approach),anterior cervical approach and posterior midline approach combined with internal fixation and bone grafting and fusion.Total laminectomy with laminoplasty or semi-laminectomy was performed via posterior midline approach.Thoracic tumor was resected by semi-laminectomy in 2 cases,by whole laminectomy in 1.All 3 lumbar tumors were resected by semi-laminectomy,2 of which were fixed by screw rods system after removing the tumor.Results Twenty tumors were totally removed,and the other 2 tumors were subtotally removed.In all the cases,the symptoms released obviously after operation.Eighteen patients were followed up for 9-18 months,and no tumor relapse or instability of the spine was found.Conclusion Most dumbbell-shaped tumors of the spinal canal can be removed by semi-laminectomy,while far lateral approach is suitable for large tumors in the upper cervical segment.Internal fixation is necessary after the tumor was removed for the patients who had severe bony destruction due to the tumor and those whose small joints are completely removed.