Posterior Hemi-/Laminectomy and Facetectomy Approach for the Treatment of Dumbbell-Shaped Schwannomas in the Subaxial Cervical Spine: A Retrospective Study of 26 Cases

Abstract

Objective: It is difficult to completely and safely remove a tumor that is located in the subaxial cervical spine by using the posterior approach because of the anatomical characteristics. Previous reports regarding the total removal of subaxial schwannomas using the one-stage posterior approach are still limited. This study was to evaluate the feasibility and efficacy of treating the dumbbell-shaped schwannomas in the subaxial cervical spine using the one-stage posterior approach. Methods: Patients with dumbbell-shaped schwannomas in the subaxial cervical spine were treated using the one-stage posterior approach. Surgical profile, clinical outcomes, MRI and X-ray images, and complications were investigated. Japanese Orthopaedic Association (JOA) score and McCormick functional schema score were obtained. Results: The average follow-up was 21.5 ± 5.1 months, with a range of 12–31 months. Twenty-six patients were enrolled in the study. Total resection was achieved in all patients using the one-stage posterior approach with hemi- or laminectomy and facetectomy. All cases underwent lateral mass screw fixation and fusion. JOA improved significantly (p < 0.01). The McCormick score improved significantly (p < 0.05) after the surgery. No mortality, morbidity, or tumor recurrence was observed during the follow-up period. Conclusion: Our technique was feasible and effective for the treatment of dumbbell schwannomas in the subaxial cervical spine. The tumor could be totally removed in most cases safely.

Clinical Efficacy of Laminectomy with Instrumented Fixation in Treating Thoracolumbar Intradural Extramedullary Schwannomas: A Comparative Study

“…However, no significant differences were detected between the 2 groups in JOA-T score or JOA-L score. The neurological function was much improved, which is not only indicated by most patients being very satisfied with their treatment results, but is also in line with some previous reports that documented the improvements caused by laminectomy with or without internal fixation [4,30]. Here, it cannot be neglected that there is a close correlation between functional scores and radiographic parameters, including sagittal balance parameters [31,32].…”

Biomechanical Evaluation of Subaxial Lateral Mass Prothesis: A Finite Element Analysis Study

“…Therefore, to expose a dumbbell tumor originating from the nerve root during surgery, it is necessary to resect the whole or part of the lateral mass. [15] In addition, primary spinal tumors often directly involve the lateral mass, and their treatment even requires total en bloc spondylectomy (including the vertebral body, lateral mass, lamina, transverse process, and other structures). In addition, infection and trauma may lead to bone destruction of lateral masses.…”

Spinal dumbbell tumors: Long-term outcome and risk factors

“…suggested that a combined anterior and posterior approaches only be performed when there is residual tumor, but this suggestion was not widely accepted by patients and required a long surgical time 14 . However, the posterior approach is popular and safe and has a low potential for damaging important structures.…”

“…However, the posterior approach is popular and safe and has a low potential for damaging important structures. As long as the VA can be visualized and protected, a one-stage posterior approach can be performed and even extended to the ventral side of the vertebral artery 14 . For these reasons, we prefer the posterior approach for our patients.…”