Surgical treatment and long-term follow-up results of dumbbell-shaped tumors of upper cervical spine
Objective:To explore the surgical treatment strategy and long-term follow-up effect of dumbbell-shaped tumor of the upper cervical spine.Methods:A total of 24 patients with dumbbell-shaped tumors of upper cervical spine treated in our hospital from January 2003 to December 2015 were retrospectively analyzed.There were 15 males and 9 females with a mean age of(48.7±13.9)years(range,35-67 years).C1-2 was invloved in 12 patients,C2 invloved in 3,C2-3 invloved in 7,and C1-3 invloved in 2.According to PUTH classification,there were 3 cases of type 2,10 cases of type 3,2 cases of type 4,6 cases of type 5,1 cases of type 6,and 2 cases of type 7.Frankel grade:3 cases of grade C,15 cases of grade D,and 6 cases of grade E.All patients were treated according to PUTH classification.The amount of intraoperative bleeding,operation time and complications were recorded.Clinical efficacy was evaluated with VAS score,Frankel grade,JOA score and KPS score,and the cervical physiological curvature and upper cervical stability were evaluated according to the X-ray examination.Results:The mean operation time was(236.6±49.8)min,and the mean intraoperative bleeding was(1 260.4±283.0)mL.All patients were followed up for 64 to 121 months,with a mean time of(87.8±9.6)months.The VAS,JOA and KPS scores at 12 months after operation and at the last follow-up were significantly improved compared with preoperative ones(P<0.05).At the last follow-up,the improvement of Frankel grade ranged from 0 to 2.The cervical physiological curvature(22.44°±9.69°)was lower than preoperative one(26.35°±12.16°)at the final follow-up,but there was no significant difference between pre and post-operative physiological curvature(t=1.23,P=0.23).No vertebral artery injury,cardiac arrest,internal fixation looseness or breakage,instability of adjacent cervical segments occurred during follow-up.Conclusions:According to the PUTH classification,the treatment strategies of the upper cervical dumbbell-shaped tumor can achieve good curative effect,which can completely remove the tumor and restore the stability of the upper cervical spine.