General Session: MIS - Hall F
Presented by: Y. Gu
(1) Zhongshan Hospital Fudan University, Orthopaedics, Shanghai, China
Introduction: The Dumbbell-shaped thoracic tumors represent a distinct type of tumor and involve in both the spinal canal and the posterior thoracic cavity. Successful treatment for the tumors depends on gross total resection (GTR) via an open laminectomy and facetectomy or transthoracic transpleural approach. However, these operations have significant morbidity related to the surgical approach, potential blood loss, or extensive dissection. In this study, we report our experiments with minimally invasive method for the removal of extradural dumbbell thoracic tumor and evaluate the feasibility, efficacy and safety of this technique.
Materials and Methods: We retrospectively reviewed 15 patients with dumbbell-shaped thoracic tumors who underwent minimally invasive resection and unilateral transforaminal thoracic intervertebral fusion (TTIF) through unilateral paraspinal muscle approach with an expandable tubular retractor from December 2013 to May 2014. The mean age was 41.3 years (range, 18-53 years). Clinical data, and tumor characteristics were analyzed. The pain intensity in the previously symptomatic region was graded with VAS. The severity of the neurologic deficit was assessed by using the ASIA impairment scale before and after surgery. The radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instability and the disc height.
Results: All patients underwent successful minimally invasive treatment of their spinal neoplasms. There were no procedure-related complications. The efficacy in terms of neurological recovery, pain improvement and operative variables (length of incision, operative duration, blood loss, and hospital stay) was better when compared with prior published studies. Postoperative CT image demonstrated complete resection of dumbbell tumor in the patients. The solid fusion was obtained after 3 months follow-up and there was no failure of internal fixation.
Conclusion: If the medial border of intracanal component of extradural dumbbell tumor is near the midline of canal and the pedicles of adjacent vertebrae to tumor are intact, minimally invasive resection of tumor through unilateral paraspinal muscle approach combined with unilateral TTIF is good choice.
Keywords: Dumbbell-shaped tumor, Minimally invasive surgery, Pedicle screw fixation, Transforaminal thoracic intervertebral fusion, Surgical techniques