Surgical Strategy for Lumbar Spine Dumbbell Tumors Based on a New Classification

• Published in: World neurosurgery Vol. 170; pp. e137 - e143
• Main Authors: Wei, Zuo, Zilong, Mao, Jian, Wang, Peng, Wang, Chao, Cheng, Jinan, Zhang, Lei, Zhang, Weixin, Li
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.02.2023
• Subjects: Classification; Lumbar spine dumbbell tumor; Surgical strategy; Lumbar spine dumbbell tumor; MRI; LDT; Classification; Surgical strategy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.10.087

Current spinal dumbbell tumor classifications are excessively focused on dumbbell tumors of the cervical spine and corresponding surgical strategies, neglecting lumbar dumbbell tumors, and appropriate strategies for such lesions. We aimed to establish a classification of lumbar dumbbell tumors (LDTs) based on diagnostic imaging and lesion location to enable the selection of optimal surgical strategies. We retrospectively analyzed 39 patients who had LDTs evaluated at a single institution. Herein, we propose categories defined by tumor position in the horizontal and longitudinal tumor length in the coronal direction. Thirty-nine patients with LDTs were surgically treated. The pathology consisted of schwannoma, neurofibroma, hemangioma, and a cyst in 33, 3, 2, and 1 cases, respectively. Based on the new classification, type IA, type IB, type IC, type ID, type IIA, type IIB, and type IIB/M were diagnosed in 6, 4, 3, 1, 20, 2, and 3 cases, respectively. Thirteen, 23, 1, and 2 patients underwent surgery using posterior, paraspinal, oblique retroperitoneal, and combined approaches, respectively. Gross total resection was achieved in all patients. The complications included cerebrospinal fluid leakage in 2 cases and infection in 1. Thirty-six patients showed clinical improvement, 2 showed no change in clinical status, and 1 was lost to follow-up because the patient's contact information changed. This classification of LDTs by their position in the coronal and axial planes is a simple and practical basis for selecting a surgical approach.