A Complete Facet Resection and Cervical Pedicle Screw Placement Enhances Both Gross Total Resection and Motion Preservation for the Cervical Spinal Dumbbell Tumor.

Abstract

Objective: To describe single-index-level fusion surgery using a cervical pedicle screw (CPS) after the complete facet resection of spinal dumbbell tumors and to compare it with partial facet resection without fusion.

Methods: We retrospectively reviewed patients who underwent surgery for dumbbell-shaped cervical spine tumors. They were categorized into the fused group (complete facet resection with fusion using CPS) and the unfused group (partial facet resection without fusion). We compared demographics, tumor characteristics, resection rates (gross total, subtotal, or partial), and regrowth rates between the groups. Complete facet resection was performed for maximal tumor removal. In the fused group, single-index-level fusion was achieved using CPS. Despite tumor-associated erosion of the index vertebra's pedicle and/or lateral mass, the CPS was directly inserted into the vertebral body through an imaginary virtual pedicle without a lateral mass or pedicle purchase.

Results: A total of 34 patients underwent surgery for dumbbell-shaped cervical tumors; half were classified into each group. There were no significant differences in demographic or tumor characteristics, including Asazuma classification, or histological diagnosis (P > 0.05). However, the gross total resection rate was significantly higher in the fused group (16/17, 94.1% vs. 9/17, 52.9%; P value = 0.011). Tumor recurrence was observed in 3 (17.6%) patients in the unfused group; no recurrence (0%) occurred in the fused group.

Conclusions: Complete facet resection with fusion using CPS significantly increased the gross total tumor removal rate, compared with partial resection without fusion. Therefore, CPS improved fusion surgery for maximal motion preservation, resulting in single-level fusion surgery.