Surgical Removal of Spinal Mass Lesions with Open Door Laminoplasty

Abstract

Objective: The open door laminoplasty technique has been previously used to treat cervical spondylotic myelopathy. We adapted this technique for the removal of spinal tumors all along the spinal axis.

Methods: Between January 2002 and January 2003, 17 patients with various intraspinal lesions underwent open door laminoplasty. The thoracal level was involved in 10 cases, the cervical level in 3 patients and the lumbar level in 4. Location of the tumor was intradural-intramedullary in 7, intradural-extramedullary in 6 and extradural in 4 patients. The histological diagnoses were 4 astrocytomas, 2 meningiomas, 3 neurinomas, 2 ependymomas and one case each with Ewing's sarcoma, metastasis, abcess, hemangioblastoma, arachnoid cyst and lipoma.

Results: All lesions were exposed using the open door laminoplasty technique and were successfully removed for intraspinal mass lesions. An average of 3.7 level laminoplasty was performed. Neither spinal malalignment on the coronal plane nor displacement of bone flap (laminoplasty flap) were observed on postoperative CT and MR examinations. No complications due to laminoplasty were encountered. The mean follow-up was 30 months (range 22–48 months).

Conclusion: Open door laminoplasty is a simple procedure and has two main advantages over the classical laminectomy procedure; a lower incidence of spinal deformities with or without neurological deficits and an absence of epidural scar tissue. This procedure can be used in all spinal cases with intraspinal mass lesions.

Key words

laminoplasty - spinal - tumor

References

• 1 Baisten J, Voo L, Cusick J. et al . Evaluation of cervical laminectomy and laminoplasty.  Spine. 1999;  24 1283-1289
• 2 Casha S, Engelbrecht HA, DuPlessis SJ. et al . Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages, and complications.  J Neurosurg Spine. 2004;  1 (1) 80-86
• 3 Fields M, Hoshijima K, Feng A. et al . A biomechanical, radiologic and clinical comparison of outcome after multilevel laminectomy or laminoplasty in the rabbit.  Spine. 2000;  22 2925-2931
• 4 Fraser RD, Paterson DC, Simpson DA. Orthopaedic aspects of spinal tumors in children.  J Bone Joint Surg (Br). 1977;  59 (2) 143-151
• 5 Hirabayashi H, Satomi K. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.  Spine: State of the Art Reviews. 1987;  1 517-532
• 6 Hirabayashi H, Satomi K. Operative procedure and results of expansive open-door laminoplasty.  Spine. 1988;  13 870-876
• 7 Hirabayashi K, Watanabe K, Wakano K. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.  Spine. 1983;  8 693-699
• 8 Inoue A, Ikata T, Katoh S. Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve.  Spinal Cord. 1996;  34 (9) 536-542
• 9 Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor.  Spine. 1989;  14 (11) 1171-1176
• 10 Lonstein JE. Post-laminectomy kyphosis.  Clin Orthop. 1977;  128 93-100
• 11 Mehlman CT, Crawford AH, McMath JA. Pediatric vertebral and spinal cord tumors: a retrospective study of musculoskeletal aspects of presentation, treatment, and complications.  Orthopedics. 1999;  22 (1) 49-56
• 12 Morimoto T, Ohtsuka H, Sakaki T. et al . Postlaminectomy cervical spinal cord compression demonstrated by dynamic magnetic resonance imaging. Case report.  J Neurosurg. 1998;  88 (1) 155-157
• 13 Morio Y, Yamamoto K, Teshima R. et al . Clinicoradiologic study of cervical laminoplasty with posterolateral fusion or bone graft.  Spine. 2000;  25 190-196
• 14 Oiwa T, Hirabayashi K, Uzawa M. et al . Experimental study on postlaminectomy deterioration of cervical spondylotic myelopathy. Influences of intradural surgery and persistent spinal block.  Spine. 1985;  10 (8) 717-721
• 15 Raimondi AJ, Gutierrez FA, Di Rocco C. Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood.  J Neurosurg. 1976;  45 (5) 555-560
• 16 Ratliff JK, Cooper PR. Cervical laminoplasty: a critical review.  J Neurosurgery (Spine 3). 2003;  98 230-238
• 17 Roselli R, Pompucci A, Formica F. et al . Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring.  J Neurosurg. 2000;  92 (1) 38-43
• 18 Sarioglu AC, Hanci M, Bozkus H. et al . Unilateral hemilaminectomy for the removal of the spinal space-occupying lesions.  Minim Invasive Neurosurg. 1997;  40 74-77
• 19 Shimizu T, Saito N, Aihara M. et al . Primary spinal oligoastrocytoma: Case Report.  Surg Neurol. 2004;  61 77-81
• 20 Tsuzuki N, Abe R, Saikai K. et al . Tension band laminoplasty of the cervical spine.  Int Orthop. 1996;  20 275-284
• 21 Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults.  J Neurosurg. 1982;  57 4415-4445
• 22 Yeh JS, Sgouros S, Walsh AR. et al . Spinal sagittal malalignment following surgery for primary intramedullary tumours in children.  Pediatr Neurosurg. 2001;  35 (6) 318-324
• 23 Wang MY, Green BA. Open-door cervical expansile laminoplasty.  Neurosurgery. 2004;  54 (1) 119-123
• 24 Zdeblick T, Abitbol JJ, Kunz DN. Cervical stability after sequential capsule resection.  Spine. 1993;  18 2005-2008
• 25 Zdeblick T, Zou D, Warden KE. Cervical stability after foraminotomy: A biomechanical in vitro analysis.  J Bone Joint Surg Am. 1992;  74 22-27

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