Okubo Toshiki, Nagoshi Narihito, Tsuji Osahiko, Ozaki Masahiro, Suzuki Satoshi, Takahashi Yohei, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Global Spine J. 2025 Mar;15(2):790-799. doi: 10.1177/21925682231212724. Epub 2023 Oct 29.
A retrospective comparative study.
This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors.
Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine).
The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups.
Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.
一项回顾性比较研究。
本研究调查了胸段哑铃形肿瘤患者在未进行脊柱融合的肿瘤切除术后，全脊柱矢状面排列（GSSA）的影像学变化及临床结局。
本研究纳入了30例随访至少3年的胸段哑铃形肿瘤患者。使用X线片测量的个体GSSA参数分析结局变量的变化。采用改良麦考密克量表（MMCS）、日本矫形外科学会（JOA）评分和视觉模拟量表（VAS）评估临床结局。为评估受累节段对这些结局的影响，我们根据肿瘤位置（上胸段[T1-4]、中胸段[T5-8]或下胸段[T9-12]）将患者分为三组。
所有患者的GSSA参数（颈椎前凸、T1斜率、胸椎后凸[全段、上段、中段和下段]、胸腰段后凸、腰椎前凸、骶骨斜率、骨盆入射角和骨盆倾斜度）在术后均无显著变化。30例患者中有11例术前存在步态障碍，但在末次随访时能够独立行走（MMCS分级为I级或II级）。JOA评分和VAS评分术后均有显著改善。上、中、下三组之间术后各矢状面形态或临床结局均未观察到统计学显著差异。
未进行脊柱融合的肿瘤切除未影响各种GSSA参数，且临床结局满意，这表明在切除胸段哑铃形肿瘤时可能并非总是需要进行脊柱融合。
