Unilateral hemilaminectomy for patients with intradural extramedullary tumors

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.

Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors:an operative technique and short-term outcomes of 20 consecutive cases

Background:To present a surgical technique for the treatment of intradural extramedullary(IDEM)tumors by using endoscopically controlled surgery with open hemilaminectomy technique.Methods:In this study,20 patients with 22 IDEM tumors were enrolled.An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors.Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis.Results:All the tumors in 20 patients were well removed.The clinical symptoms were significantly reduced in all the patients as well.The short-term follow-up data showed that there was no tumor recurrence or spinal deformity.Conclusion:The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors.It may be an effective surgical method for treating IDEM tumors.Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.