Clinical Implications of Surgical Resection without Spinal Fixation in Lumbar Dumbbell Tumors: Evaluating Postoperative Lumbar Alignment and Patient Outcomes.

Abstract

This study examined radiographic changes in local and global spinal alignments and clinical outcomes following tumor resection without spinal fixation in patients with lumbar dumbbell tumors (LDTs). We included 28 patients with LDTs who were followed for at least 2 years after surgery. We analyzed variations in the outcome variables by measuring individual coronal and sagittal parameters from radiographs. Clinical outcomes were assessed using the modified McCormick scale, the Japanese Orthopedic Association score, and the visual analog scale. To evaluate the impact of tumor location on these outcomes, we categorized the patients into 3 groups based on tumor location: upper (T12-L1), middle (L2-3), or lower (L4-S1) group. The local and global spinal parameters (including Cobb angle, cervical lordosis, T1 slope, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis [global, upper, middle, lower], sacral slope, pelvic incidence, and pelvic tilt) did not show significant changes after surgery. Preoperatively, all patients experienced gait disturbances, but at the final follow-up, nearly all of them (27 cases, 96.4%) could walk without support. The Japanese Orthopedic Association score and visual analog scale demonstrated significant postoperative improvements. There were no statistically significant group differences in postoperative coronal and sagittal profiles or clinical outcomes among the upper, middle, and lower groups. Tumor resection without spinal fixation had no substantial impact on local and global spinal alignments and led to satisfactory clinical outcomes, suggesting that spinal fixation may not always be necessary when resecting LDTs.