Minimally invasive resect... (2018)
by Fahed Zairi, Camille Troux, Tarek Sunna, Melodie-Anne Karnoub, Ghassan Boubez, and Daniel Shedid
Surgical resection is the mainstay of treatment. The objective is to achieve a complete resection while preserving neurological structures and limiting surgical morbidity. There is no consensus on the surgical technique and approach to use, due to the diversity of clinical and radiological presentations, as well as the diverse opinions and experiences of surgical teams. However, it is well recognized that the posterior approach allows the resection of the majority of located lesions in the spinal canal. For such location, the recent introduction of minimally invasive techniques has led to a significant reduction of the overall operative morbidity and a limitation of bony resection, reducing iatrogenic instability. With regard to dumbbell tumors, the technical considerations are even more complex. First, the foraminal extension may require a complete arthrectomy and the systematic achievement of a posterior stabilization. Second, the extra-vertebral extension may be significant and require for some a previous or complementary anterior approach to control visceral and vascular structures. Recently, some teams have mentioned the value of using minimally invasive trans-muscular retractors in such situations. With regard to these rare case reports, minimally invasive access is likely to spare the facet process and to avoid the need of an additional anterior approach. Nevertheless, there is to date a lack in the literature that does not allow the widespread use of this technique. This work aims to report a consecutive series of 8 patients operated on for the resection of a voluminous lumbar dumbbell tumor via a single posterior minimally invasive approach, and to discuss the main technical aspects and limitations.🏁
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Surgical resection is the mainstay of treatment. The objective is to achieve a complete resection while preserving neurological structures and limiting surgical morbidity. There is no consensus on the surgical technique and approach to use, due to the diversity of clinical and radiological presentations, as well as the diverse opinions and experiences of surgical teams. However, it is well recognized that the posterior approach allows the resection of the majority of located lesions in the spinal canal. For such location, the recent introduction of minimally invasive techniques has led to a significant reduction of the overall operative morbidity and a limitation of bony resection, reducing iatrogenic instability. With regard to dumbbell tumors, the technical considerations are even more complex. First, the foraminal extension may require a complete arthrectomy and the systematic achievement of a posterior stabilization. Second, the extra-vertebral extension may be significant and require for some a previous or complementary anterior approach to control visceral and vascular structures. Recently, some teams have mentioned the value of using minimally invasive trans-muscular retractors in such situations. With regard to these rare case reports, minimally invasive access is likely to spare the facet process and to avoid the need of an additional anterior approach. Nevertheless, there is to date a lack in the literature that does not allow the widespread use of this technique. This work aims to report a consecutive series of 8 patients operated on for the resection of a voluminous lumbar dumbbell tumor via a single posterior minimally invasive approach, and to discuss the main technical aspects and limitations.🏁