A comparison of the surgical effects of lumbar spinal dumbbell-type tumor resecting via anterolateral retroperitoneal approach and posterior median approach

KONG Fanxuan; SHI Tiejun; GU Jianwen; WANG Tao; Tan Rong; SUN Yikun; SHI Quanxing; LI Nan; WANG Peixin

Abstract：Objective To compare the therapeutic efficacy of surgical resection of dumbbell-type tumors inside and outside the spinal canal via the anterolateral retroperitoneal approach and posterior median approach so as to provide a new choice of surgical approaches for this type of tumor. Methods Retrospective analysis of 25 patients of dumbbell-type tumors inside and outside the lumbar spine treated at the Ninth Medical Center of the PLA General Hospital since 2010 was made by dividing them into the anterior lateral group (using the anterolateral retroperitoneal approach) and the posterior median group (using the posterior median approach). Statistical analysis was conducted on the preoperative basic information,lumbar spine JOA score,postoperative JOA score,and postoperative complications. Results There was no significant difference in preoperative lumbar JOA score between the two groups. There was no significant difference in the improvement rate between the two approaches 3 months after surgery (P=0.887>0.05). Postoperative cerebrospinal fluid leakage in the anterolateral group was less than that in the median group,but the sample size was too small for statistical comparison. Conclusions According to the volume and shape of the outer part of the spinal canal,dumbbell-type tumor can be divided into 3 types for treatment. For Type Ⅰ,as the volume of the tumor's outer part of the spinal canal is less than or equal to that of the spinal canal,the posterior median approach is recommended. For Type Ⅱ,as the long axis of the tumor outside the spinal canal is parallel to or nearly parallel to the spinal axis,which involves multiple stages,the para-median approach should be adopted. For Type Ⅲ,as the volume of the tumor outside the spinal canal is larger than the inside part of the spinal canal,and the length of the long and short axes is approximately equal or the tumor shape is irregular,two different approaches can be taken,i.e.,for Type Ⅲb (the distance between the lateral line of the tumor outside the spinal canal and the midline of the spine is less than 4 cm),the posterior median approach can be used,and for Type Ⅲa( the distance between the lateral line of the tumor outside the spinal canal and the midline of the spine is larger than 4 cm),the anterolateral retroperitoneal approach can be used.