Management of Dumbbell and Paraspinal Tumors of the Thoracic Spine Using a Single‐stage Posterolateral Approach: Case Series

Rong, Hongtao; Fan, Yueshan; Li, Sipeng; Zhang, Zheng-shan; Liu, Hui; Liu, Tong; Zhu, Tao; Zhang, Jianning

doi:10.1111/os.12405

Cited by 17 publications

(11 citation statements)

References 22 publications

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“…Using the extensive posterolateral approach enabled us to achieve maximal tumor resection and spine instrumentation in a one-step procedure. Similar results were achieved in other recent clinical studies that addressed the posterolateral approach (6)(7)(8)(9)(10)(11)(12). Despite its relative invasiveness, we confirmed that such an approach is safe and predictable as it is more familiar to neurosurgeons than the transthoracic approach, that usually requires the assistance of thoracic surgeons as well.…”

Section: Discussionsupporting

confidence: 90%

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Ravnik

Stangelj

Košar

2021

ama

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Objective. Our objective was to determine the safety, efficacy, and surgical outcome of an extensive posterolateral approach for giant spinal epidural tumors.Materials and Methods. Our clinical study included 12 patients with various giant primary tumors and metastases of the spine, who underwent surgery between 2008 and 2019. The surgical procedure consisted of costotransversectomy, laminectomy, corpectomy, tumor resection, spinal column stabilization, and reconstruction. Neurological status examination and pain assessment were recorded at the time of admission, upon discharge and at outpatient check-up.Results. In our clinical sample, there were no major perioperative complications. All patients were discharged from the intensive care unit back to the hospital department within a week after the surgery. Postoperative follow-up showed no deterioration of neurological status. Furthermore, there was a moderate to significant improvement of paraparesis in all patients for weeks after surgery. The most notable improvement was significant pain relief in all the patients. None of the patients had issues with failure of the implanted hardware. Two patients died less than six months after the surgery due to the progression of the primary malignant process.Conclusion. An extensive posterolateral approach to giant spinal epidural tumors is an effective one-step approach. It presents a good compromise between invasiveness and sufficient exposure for both tumor resection and spinal column reconstruction. Good short-term clinical improvement can be achieved, but the long term results depend on the advancement of the initial disease. Careful evaluation and selection of patients are necessary to achieve clinical improvement and prolonged life expectancy, and the best results are achieved with a multidisciplinary approach.

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Section: Discussionsupporting

confidence: 90%

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Ravnik

Stangelj

Košar

2021

ama

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“… 12 Rong et al reported a series of 14 patients undergoing posterolateral resections without instrumentation. 17 Mean operative time and estimated blood loss were comparable with Li et al (272 min and 529 ml, respectively); however, one patient had subtotal resection and recurrence of disease. Zairi et al reported a series of five dumbbell tumors with mean maximal dimension of 46 mm resected by a posterior‐only approach.…”

Section: Discussionsupporting

confidence: 72%

“…Li et al reported favorable operative time (222 min), blood loss (400 ml), length of stay (8 days) and reduced pulmonary complications versus a combined approach 12 . Rong et al reported a series of 14 patients undergoing posterolateral resections without instrumentation 17 . Mean operative time and estimated blood loss were comparable with Li et al (272 min and 529 ml, respectively); however, one patient had subtotal resection and recurrence of disease.…”

Section: Discussionmentioning

confidence: 89%

Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series

et al. 2021

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Background Paraspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video‐assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors. Methods A retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range. Results Seven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow‐up of 54 months. Conclusions Our experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold‐standard approach for thoracic neurogenic dumbbell tumors.

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“…They reported that the mean intraoperative blood loss was 360 mL, and the mean duration of using a drainage tube was 3 days 15 . With the development of minimally invasive techniques and devices, new surgical approaches have been used to remove thoracic dumbbell tumors in one operation and reduce unnecessary iatrogenic injuries caused by combining approaches [16][17][18] . Tubular or expandable retractors in tubular spinal surgery can expose tumors by expanding muscles in a stepwise manner, which not only reduces muscle and ligament injuries but also addresses tumor tissue in the epidural space.…”

Section: Advantages Of Tubular Spine Surgery For Thoracic Dumbbell Tumorsmentioning

confidence: 99%

Efficacy of One‐stage Paravertebral Approach using a Micro‐Tubular Technique in Treating Thoracic Dumbbell Tumors

Wang

Chen

Liang

et al. 2021

Orthopaedic Surgery

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The aim of the present study was to investigate the feasibility and efficacy of one-stage surgical resection of thoracic dumbbell tumors using a paravertebral approach and a micro-tubular technique.Methods: Clinical data of thoracic dumbbell tumors resected using a paravertebral approach and a micro-tubular technique (14 mm, non-expandable type) in the Department of Neurosurgery at our hospital from July 2014 to July 2019 were retrospectively analyzed. Tumors were found between T1 and T12 vertebrae. Operation time, blood loss, hospitalization, recovery of neurological function, complications, the Japanese Orthopaedic Association (JOA) score, and the visual analogue scale (VAS) score were used to evaluate clinical efficacy.Results: In all 31 cases, tumors were completely resected in one operation, with a mean blood loss of 53.23 AE 33.08 mL (20-150 mL) and a mean operation time of 95.16 AE 20.31 min (60-180 min). According to the Eden classification, there were four type II cases, 16 type III cases, and 11 type IV cases. The incidence of tumors in the lower thoracic segment (T8-T12) was 51.6% (16/31 cases), while the incidences in the upper thoracic segment (T1-T4) and middle segment (T5-T8) were 25.8% (8/31 cases) and 22.6% (7/31 cases), respectively. Pathological diagnoses were schwannoma (n = 22), gangliocytoma (n = 4), metastatic tumor (n = 2), neurofibroma (n = 1), granuloma (n = 1), and lipoma (n = 1). After surgery, symptoms were relieved in all patients. VAS and JOA scores significantly improved (P < 0.001). There was no pleural or lung injury, and there were no complications, such as cerebrospinal fluid leakage. The average follow-up duration was 29 months (13-59 months), during which time no tumor recurrence or spinal instability occurred. The group of Eden type II tumors had lower JOA scores at 12 months postoperatively, longer operation times, and more estimated blood loss compared with other groups (P < 0.05). There were no significant influences on VAS scores at 12 months postoperatively and postoperative hospital stay from the different types of tumors. Conclusion:The paravertebral approach with a micro-tubular technique is a safe and effective minimally invasive surgical approach for thoracic dumbbell tumors that allows one-stage tumor resection using a single incision. Using this approach significantly reduces intraoperative blood loss and postoperative complications, shortens hospital stay, and reduces the rates of postoperative spinal instability.

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Management of Dumbbell and Paraspinal Tumors of the Thoracic Spine Using a Single‐stage Posterolateral Approach: Case Series

Cited by 17 publications

References 22 publications

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series

Efficacy of One‐stage Paravertebral Approach using a Micro‐Tubular Technique in Treating Thoracic Dumbbell Tumors

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