Surgical Strategy for Spinal Dumbbell Tumors: A New Classification and Surgical Outcomes.

STUDY DESIGN: One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification.

OBJECTIVE: To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach.

SUMMARY OF BACKGROUND DATA: Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters.

METHODS: The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures.

RESULT: Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient.

CONCLUSION: The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach.

LEVEL OF EVIDENCE: 4.