Analysis of individual surgical treatment for cervical dumbbell⁃shaped tumors

Abstract

Objective To discuss the strategy for cervical dumbbell⁃shaped tumors and develop a proposal for individualized therapy. Methods and Results Total 32 patients with cervical dumbbell⁃shaped tumors were recruited from The First Affiliated Hospital of Anhui Medical University from March 2017 to March 2022. All patients received surgical treatments, while the tumors located in C1-2 levels among 7 patients and C2-7 levels among 25 patients. Preoperative McCormick spinal cord function gradeⅠin 9 cases, gradeⅡin 12 cases, grade Ⅲ in 11 cases. Individualized surgical strategies were set according to the results of Toyama typing, preoperative imaging examination and intraoperative spinal stability. Surgery through posterior approach was performed in 26 cases, 2 patients underwent a lateral posterior sternocleidomastoid approach, 2 patients underwent surgery through combined posterior⁃anterolateral approach, and 2 patients received anterior cervical approach. Ninteen out of 32 patients with preoperatively unstable spinal factors or changes in spinal stability resulting from surgery received one⁃stage internal fixation. One patient underwent anterior cervical corpectomy and fusion followed by titanium cage implantation, and 18 patients underwent posterior trans⁃pedicle and lateral mass screw fixation. The results showed a gross total resection for all patients and the success rate was 100% (32/32). The average intraoperative blood loss was about 210 ml. Imaging examinations were performed for all patients within a week after the surgery, the internal fixator were all in good position. One month after the surgery McCormick spinal cord function gradeⅠin 20 cases, gradeⅡin 10 cases, grade Ⅲ in 2 cases. All patients had varying degrees of improvement in symptoms, no cerebrospinal fluid leakage, no serious nervous system infection and other complications, no postoperative cervical kyphosis, and no loosening or breakage of the screws and rods were found in 28 months after surgery, the bone graft fusion and vertebral body shape were good. Conclusions The size of the intervertebral foramen is one of the important factors to be considered in the surgical strategy of cervical dumbbell⁃typed tumors. The surgical management of C1-2 dumbbell⁃typed tumors is different from that of other levels, it is necessary to understand the patient's medical history, symptoms and signs in detail and to improve imaging evaluation before surgery. The development of multiple techniques and typing methods facilitate the development of individualized surgical plans.

Keywords

• spinal neoplasms
• cervical vertebrae
• microsurgery
• internal fixators