Abstract:

Objective　To evaluate the anatomic feasibility and security of a single-stage posterior approach with costotransversectomy only for the management of thoracic dumbbell tumors.　Methods　The clinical and radiologic data of 20 cases of thoracic dumbbell tumor between 2006 to 2011 were analyzed retrospectively. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversection combined with instrumentation. Clinical and radiologic outcomes were evaluated. Neurological function was evaluated by the JOA score before surgery and at the final follow-up, the effect of internal fixation and fusion was evaluated by X-ray, and observance of whether the tumor was resected completely or tumor recurred  at the final follow-up were made by MRI.  Results　Operative time ranged from 152 to 420 minutes (mean, 263 minutes), with estimated blood loss ranging from 125 to 1770 mL (mean, 480 mL). All cases (including 12 cases in the epidural space and 8 cases in subdural space) had tumors removed completely. Pathologic findings included schwannoma in 9, neurofibroma in 6 , spinal meningioma in 3 and ganglioneuroma in 1 case. Postoperative complications included atelectasis in 1 case. The neurological function was significantly improved at the end of the follow-up, the recovery rate of JOA score was 72.9%; the VAS score was reduced from 8.3±0.67 before surgery to 2.3±0.19 at the end of follow-up. Spinal deformities, and tumor recurrence were not observed in any patients at the final follow-up; postoperative complications include pleural injury in 2 cases, pulmonary atelectasis in 1 case and cerebrospinal leak within the chest in 1 case.　Conclusion　Single-stage posterior approach with costotransversectomy may be a good choice for neurogenic thoracic dumbbell that has slight adhesion to great vessel and lung.

Key words: Thoracic vertebra, Dumbbell tumors, Single-stage posterior approach