Extensive posterolateral exposure and total removal of the giant extraforaminal dumbbell tumors of cervical spine: surgical technique in a series of 16 patients.
BACKGROUND
Removal of cervical dumbbell tumors can be particularly challenging because of unique exposure requirements and proximity of the vertebral artery (VA). There are no reports describing the treatment of giant cervical spine dumbbell tumors (CSDTs).


OBJECTIVE
To introduce an extensive posterolateral approach to CSDTs involving total lateral mass resection and laminectomy.


METHODS
Prospective study of all the patients with multilevel CSDTs treated by this new procedure between December 2002 and March 2006.


METHODS
Sixteen patients (3 men and 13 women) with CSDTs underwent the procedure we describe. The follow-up periods ranged from 9 to 51 months (average 9 months). Average age at surgery was 45 years (range 23-68 years).


METHODS
Axial symptoms and Japanese Orthopedic Association scores were recorded. Pre- and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs.


METHODS
After making a midline incision, we preferred exposing the extraforaminal component of the tumor before performing a semilaminectomy and lateral mass resection. Any lateral extension of a tumor can be attained by detachment of the adjacent three or more segments of the lateral mass muscle insertion. The most lateral portion can be separated beneath the tumor's superficial muscle flap, and then when the tumor is retracted medially, the whole portion of the lateral component can be totally exposed. We then performed total lateral mass resection and laminectomy to expose the tumor at the foramina and cervical canal.


RESULTS
We were able to completely resect the tumors in every patient. The average duration of surgery was 150 minutes. Blood loss was minimal (average 400 mL). All patients were monitored for a minimum of 9 months (range 9-51 months; mean 28 months). The follow-up period was uneventful, and no patients developed spinal instability.


CONCLUSIONS
Extensive posterolateral exposure enables surgeons to reach the lateralmost portion of CSDTs and also facilitates septation of the VA and resection of vertebral body encroachment of the tumor.
Zhao
Bizeng
B
Department of Orthopedics, Sixth Hospital, No. 600 Yishan Rd, Shanghai 200233, China. zhaobizeng@yahoo.com.cn
Xu
Jianguang
J
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult