title: Results of surgical treatment of cervical dumbbell tumors: surgical approach and development of an anatomic classification system.
abstract: METHODS
  A retrospective study of a new classification and surgical approach of cervical dumbbell tumors.
  
  
  OBJECTIVE
  To evaluate PUTH classification.
  
  
  BACKGROUND
  The high recurrence rate and postoperative deformity are unsolved problems. Asazuma's landmark classification could not cover all cases and could not provide clear suggestion for the surgical approach. The ideal classification should be comprehensive, easily understood and of practical value.
  
  
  METHODS
  PUTH classification for cervical dumbbell tumors includes 7 categories (types 1-7) and 2 foraminal modifiers. Posterior approach is appropriate for type 1, 2 and 5 tumors, anterior and anterolateral approach is an ideal choice for type 4 and 6 tumors. Type 7 tumors need combined anterior and posterior approach.
  
  
  RESULTS
  Forty-four consecutive patients with cervical dumbbell tumor were surgically treated. The pathology included schwannoma in 31 cases, neurofibroma in 9 and ganglioneuroma in 4. Based on PUTH classification, type 3 was diagnosed in 13 cases, type 5 in 17, type 6 in 8, and type 7 in 6. Tumors were unilateral in 41 cases, and bilateral in 3 cases. Five were tumor revision cases. Thirty patients underwent posterior approach, 7 had anterior approach, 1 had anterolateral approach, and 6 had combined approach. Gross total resection was achieved in all the patients. Tumors involved nerve roots were transected in 12 cases. Single vertebral artery was ligated in 3. The complications included cerebrospinal fluid leakage in 18 cases, esophagus injury in 1, Horner syndrome in 1, dysphagia in 2, dyspnea in 1 and deep infection in 1. Thirty-six cases (81.1%) had an average 61-month follow-up. Recurrence was found in only one case (2.8%).
  
  
  CONCLUSIONS
  PUTH classification covers all tumor types and is easier to remember. It is practical and useful for determining the surgical approach. The recurrence rate decreases significantly after radial tumor resection. Revision surgeries are associated with more complications.
authors.affiliation: Orthopaedic Department of Peking University Third Hospital, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Jiang
authors.forename: Yang
authors.initials: Y
authors.lastname: Lv
authors.forename: Xiao Guang
authors.initials: XG
authors.lastname: Liu
authors.forename: Qing Jun
authors.initials: QJ
authors.lastname: Ma
authors.forename: Feng
authors.initials: F
authors.lastname: Wei
authors.forename: Geng Ting
authors.initials: GT
authors.lastname: Dang
authors.forename: Zhong Jun
authors.initials: ZJ
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005729:Ganglioneuroma / Q000145:classification / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009442:Neurilemmoma / Q000145:classification / Q000473:pathology / Q000601:surgery*; D009455:Neurofibroma / Q000145:classification / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010524:Peripheral Nervous System Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013115:Spinal Canal / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome