Similar articles

Abstract: A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors. Forty-five consecutive patients with intradural extramedullary lesions, who underwent modified hemilaminectomy, were studied retrospectively. The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm), in which the inner parts of the medial and lateral laminae were mostly undercut for wider view. Spinal lesions were cervical in 21 cases, thoracic in 12 cases, lumbar in 10 cases, and multiple in 2 cases. Forty-three cases were completely excised via hemilaminectomy alone. Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy. With respect to neurological status, the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up. At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI), none of the subjects showed spinal deformity or instability. By preserving musculoligamentous attachments and posterior bony elements as much as possible, the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors, especially in patients with meningiomas and neurinomas.

[1]Abbott, R., Feldstein, N., Wisoff, N., Epstein, F.J., 1992. Osteoplastic laminotomy in children. Pediatr. Neurosurg., 18(3):153-156.

[2]Alexander, E.Jr., 1985. Postlaminectomy Kyphosis. In: Wilkins, R.H., Rengachary, S.S. (Eds.), Neurosurgery. McGraw Hill, New York, p.2293-2297.

[3]Balak, N., 2008. Unilateral partial hemilaminectomy in the removal of a large spinal ependymoma: case report and technical review. Spine J., 8(6):1030-1036.

[4]Banczerowski, P., Veres, R., Vajda, J., 2009. Modified minimally invasive surgical approach to cervical neuromas with intraforaminal components: hemi-semi-laminectomy and supraforaminal burr hole (modified foraminotomy) technique. Minim. Invasive Neurosurg., 52(1):56-58.

[5]Boström, A., Burgel, U., Reinacher, P., 2008. A less invasive surgical concept for the resection of spinal meningiomas. Acta Neurochir., 150(6):551-556.

[6]Cheng, M.K., 1982. Spinal cord tumors in the People’s Republic of China: a statistical review. Neurosurgery, 10(1):22-24.

[7]Chiou, S.M., Eggert, H.R., Laborde, E.G., Seeger, W., 1989. Microsurgical unilateral approaches for spinal tumor surgery: eight years’ experience in 256 primary operated patients. Acta Neurochir., 100(3-4):127-133.

[8]de Jonge, T., Slullitel, H., Dubousset, J., Miladi, L., Wicart, P., Illes, T., 2005. Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumors. Eur. Spine J., 14(8):765-771.

[9]Denis, F., 1983. The three column spine and its significance in the classification of acute thoracolumbar injuries spinal. Spine, 8(8):817.

[10]Eggert, H.R., Scheremet, R., Seeger, W., Gaitzsch, J., 1983. Unilateral microsurgical approaches to extramedullary spinal tumors. Operative technique and results. Acta Neurochir., 67(3-4):245-253.

[11]Frankel, H.L., Hancock, D.O., Hyslop, G., Melzak, J., Michaelis, L.S,, Ungar, G.H., Vernon, J.D., Walsh, J.J., 1969. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia, 7(3):179-192.

[12]Gros, C., Frerebeau, P., Privat, J.M., Benezech, J., Guillen, M., 1983. Laminectomies conservatrices lombaires. Technique et resultats. Neurochirurgie, 29(2):207-225 (in Germany).

[13]Inoue, A., Ikata, T., Katoh, S., 1996. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord, 34(9):536-542.

[14]Kim, P., Ebersold, M.J., Quast, L.M., 1989. Surgery of spinal nerve schwannoma. J. Neurosurg., 71(6):810-814.

[15]Klekamp, J., Samii, M., 1998. Surgery of spinal nerve sheath tumors with special reference to neurofibromatosis. Neurosurgery, 42(2):279-290.

[16]Koch-Wiewrodt, D., Wagner, W., Perneczky, A., 2007. Unilateral multilevel interlaminar fenestration instead of laminectomy or hemilaminectomy: an alternative surgical approach to intraspinal space-occupying lesions. J. Neurosurg. Spine, 6(5):485-492.

[17]Lonstein, J.E., 1977. Post-laminectomy kyphosis. Clin. Orthop., 128(1):93-100.

[18]Ogden, A.T., Bresnahan, L., Smith, J.S., Natarajan, R., Fessler, R.G., 2009. Biomechanical comparison of traditional and minimally invasive intradural tumor exposures using finite element analysis. Clin. Biomech., 24(2):143-147.

[19]Öktem, I.S., Akdemir, H., Kurtsoy, A., Koc, R.K., Menku, A., Tucer, B., 2000. Hemilaminectomy for the removal of the spinal lesions. Spinal Cord., 38(2):92-96.

[20]Panjabi, M.M., White, A.A.III, 1980. Basic biomechanics of the spine. Neurosurgery, 7(1):76-93.

[21]Parkinson, D., 1977. Replacement laminotomy. Surg. Neurol., 8(2):277-279.

[22]Raimondi, A.J., Gutierrez, F.A., Rocco, C.D., 1976. Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J. Neurosurg., 45(5):555-560.

[23]Reimer, R., Onofrio, B.M., 1985. Astrocytomas of the spinal cord in children and adolescents. J. Neurosurg., 63(5):669-675.

[24]Schellinger, K.A., Propp, J.M., Villano, J.L., McCarthy, B.J., 2008. Descriptive epidemiology of primary spinal cord tumors. J. Neurooncol., 87(2):173-179.

[25]Taylor, A.S., 1910. Unilateral laminectomy. Ann. Surg., 51(4):529-533.

[26]Tredway, T.L., Santiago, P., Hrubes, M.R., Song, J.K., Christie, S.D., Fessler, R.G., 2006. Minimally invasive resection of intradural-extramedullary spinal neoplasms. Neurosurgery, 58(1 Suppl.):52-58.

[27]Yao, K.C., Mcgirt, M.J., Chaichana, K.L., Constantini, S., Jallo, G.I., 2007. Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children: an analysis of 161 consecutive cases. J. Neurosurg., 107(6 Suppl.):463-468.

[28]Yasargil, M.G., Tranmer, B.I., Adamson, T.E., Roth, P., 1991. Unilateral Partial Hemilaminectomy for the Removal of Extra- and Intramedullary Tumors and AVMs. In: Symon, L. (Ed.), Advances and Technical Standards in Neurosurgery. Springer, Wien, New York, p.113-132.

[29]Yasuoka, S., Hamlet, A.P., Laws, E.R., MacCarty, C.S., 1981. Pathogenesis and prophylaxis of postlaminectomy deformity of spine after multiple level laminectomy: difference between children and adults. Neurosurgery, 9(2):145-152.

[30]Yeh, J.S., Sgouros, S., Walsh, A.R., Hockley, A.D., 2001. Spinal sagittal malalignment following surgery for primary intramedullary tumors in children. Pediatr. Neurosurg., 35(6):318-324.