Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Eur Spine J. 2021 Feb;30(2):568-575. doi: 10.1007/s00586-020-06668-1. Epub 2020 Nov 21.
PURPOSE: Cervical dumbbell tumor is usually removed via a posterior approach and may require the spinal fixation sometimes. However, the present surgical methods involved either more trauma or a higher risk of instability of the cervical spine. A new technique of unilateral exposure and stability reconstruction with pedicle and lamina screws fixation for posterior cervical dumbbell tumorectomy was described and compared with conventional techniques. METHODS: Posterior unilateral exposure, hemi-laminectomy and facetectomy were performed in one patient with the cervical dumbbell tumor between C3 and C4. The stability was reconstructed by the unilateral pedicle and lamina screws fixation (UPLS), and a strip of shaped allograft bone was also implanted between the superior and inferior lateral mass. Biomechanical stability test of this new technique was investigated using seven fresh-frozen human cervical spine specimens (C4-C7) and compared with unilateral pedicle screw (UPS) and bilateral pedicle screw fixation (BPS) techniques. A continuous pure moment of ± 2.0 Nm was applied to the specimen in flexion, extension, lateral bending and axial rotation. RESULTS: The cervical dumbbell tumor was removed completely, and bone fusion with continuous bone trabecula was maintained in the patient on the final follow-up examination at 18 months postoperatively. Biomechanical stability tests revealed that the range of motion of the UPLS fixation plus graft bone implant was the same as the BPS fixation in flexion (1.8°vs. 1.5°, p = 0.58) and extension (2.3°vs. 2.2°, p = 0.73), but significantly bigger in lateral bending (3.9° vs. 1.0°, p < 0.001) and axial rotation (6.8° vs. 3.8°, p = 0.002), which were significantly smaller than the UPS fixation in all directions (all p < 0.001). CONCLUSIONS: For the treatment of cervical dumbbell tumor, posterior unilateral exposure and stability reconstruction with pedicle and lamina screws fixation following hemi-laminectomy and facetectomy appear to be a more stable and lesser trauma technique. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
目的：颈椎哑铃状肿瘤通常通过后路切除，有时需要脊柱固定。然而，目前的手术方法要么创伤更大，要么颈椎不稳的风险更高。本文介绍了一种新的单侧暴露和稳定性重建技术，采用椎弓根和椎板螺钉固定治疗颈椎哑铃状肿瘤，并与传统技术进行比较。
方法：1 例 C3-C4 颈椎哑铃状肿瘤患者行后路单侧显露、半椎板切除和关节突切除。通过单侧椎弓根和椎板螺钉固定（UPLS）重建稳定性，并在上下外侧块之间植入条状同种异体骨。采用 7 个新鲜冷冻人颈椎标本（C4-C7）对该新技术进行生物力学稳定性测试，并与单侧椎弓根螺钉（UPS）和双侧椎弓根螺钉固定（BPS）技术进行比较。在屈伸、侧屈和轴向旋转方向施加连续纯力矩±2.0Nm。
结果：颈椎哑铃状肿瘤完全切除，术后 18 个月的最终随访检查显示，患者持续骨小梁融合。生物力学稳定性测试显示，UPLS 固定加植骨的活动度与 BPS 固定在屈伸位相同（1.8°vs.1.5°，p=0.58）和伸展位（2.3°vs.2.2°，p=0.73），但在侧屈位明显增大（3.9°vs.1.0°，p<0.001）和轴向旋转（6.8°vs.3.8°，p=0.002），均显著小于 UPS 固定在各个方向（均 p<0.001）。
结论：对于颈椎哑铃状肿瘤的治疗，后路单侧显露、半椎板切除和关节突切除后采用椎弓根和椎板螺钉固定进行稳定性重建似乎是一种更稳定、创伤更小的技术。
证据水平：诊断：个体横断面研究，具有一致应用的参考标准和盲法。
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