gms | German Medical Science

Objective: Stand-alone minimally-invasive approaches for surgical management of spinal dumbbell tumors carry the risk of incomplete resections and impaired hemostasis. In contrast, more extensive approaches require subsequent instrumentation with metal artifacts impairing follow-up imaging. Here, we present a clinical series on percutaneous instrumentation using carbon fiber reinforced polyetheretherketone (CFR-PEEK) hardware combined with a minimally-invasive posterolateral approach for tumor resection.

Methods: We present a case series of six patients with dumbbell tumors in the lumbar and thoracolumbar spine operated on between 2017 and 2020. CFR-PEEK pedicle screws and rods were inserted percutaneously. Afterwards, a dedicated self-standing retractor for posterolateral approaches was connected to the screws. Following a unilateral facetectomy the tumor was resected in a microsurgical fashion. Clinical data are reported with respect to the PROCESS guidelines.

Results: Three patients presented with de-novo tumors. Three patients were treated for residual tumor mass after previous surgeries. Gross-total resection was achieved in all six cases as demonstrated by early postoperative MRI. Histopathology demonstrated four WHO grade I schwannoma, one grade II hemangiopericytoma and one cavernous hemangioma. No postoperative complications were observed. No misplacement or failure of hardware components were observed. CFR-PEEK hardware allowed unambiguous visualization of the resection cavity on follow-up imaging.

Conclusion: Resection of dumbbell tumors via a minimally-invasive posterolateral approach and instrumentation with CFR-PEEK hardware allows maximal and safe resection. Due to lack of major metal artifacts, carbon fiber hardware improves the interpretation of follow-up imaging as well as planning radiation if required for tumor recurrence.