EFFECTIVENESS OF POSTERIOR MIDLINE APPROACH WITH COMPLETE LAMINECTOMY FOR GIANT INTRASPINAL TUMOR RESECTION AND VERTEBRAL CANAL RECONSTRUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUXuanxuan ¹ , LIHaisong ² , MAChengyuan ² , GuanYi ² ,  LIYiping ²

1. Department of Neurosurgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P. R. China;
2. Department of Neuro-Oncology Surgery, Norman Bethune First Hospital of Jilin University;

Corresponding?author：

LIYiping, Email: lyp0518@163.com

Keywords：

Posterior midline approach with complete laminectomy; Intraspinal tumor; Vertebral canal reconstruction

DOI：

10.7507/1002-1892.20140163

Video：

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Objective To investigate the effectiveness of the posterior midline approach with complete laminectomy for giant intraspinal tumor (more than 3 cm in diameter) resection and vertebral canal reconstruction. Methods Between March 2009 and February 2012, 21 cases of giant intraspinal tumor underwent the posterior midline approach with complete laminectomy and vertebral canal reconstruction. There were 12 males and 9 females with an average age of 40.5 years (range, 21-62 years). The Japanese Orthopaedic Association (JOA) scores were 0-5 in 4 cases, 6-11 in 9 cases, and 12-17 in 8 cases. The preoperative Cobb angle was less than 10°on the X-ray films. MRI showed that the tumor located at the cervical part in 3 cases, at the cervicothoracic part in 1 case, at the thoracic part in 8 cases, at the thoracolumbar part in 2 cases, and at the lumbar part in 7 cases; the long diameter of tumor on the sagittal view was 3.0-16.5 cm (mean, 8.3 cm). Total resection of tumor was performed in 17 cases, and subtotal resection in 4 cases. Results Postoperative pathological examinations showed 9 cases of neurilemmoma, 6 cases of neurofibroma, 3 cases of lipoma, 2 cases of meningioma, and 1 case of bronchogenic cyst. Primary healing of incision was achieved in all patients. The patients were followed up 1-3 years (mean, 2.3 years). Postoperative X-ray film showed that Cobb angle was more than 10°in 3 cases, and no displacement of internal fixator was observed. The JOA scores were 0-5 in 1 case, 6-11 in 10 cases, and 12-17 in 10 cases, showing significant difference when compared with preoperative scores (Z=-3.26, P=0.02). Conclusion The posterior midline approach with complete laminectomy for giant intraspinal tumor resection and vertebral canal reconstruction is a safe, simple, and feasible operation way, and it can resect tumor to a maximum extent, relieve the clinical symptoms, and maintain the spinal stability.

Citation： WUXuanxuan, LIHaisong, MAChengyuan, GuanYi, LIYiping. EFFECTIVENESS OF POSTERIOR MIDLINE APPROACH WITH COMPLETE LAMINECTOMY FOR GIANT INTRASPINAL TUMOR RESECTION AND VERTEBRAL CANAL RECONSTRUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(6): 733-736. doi: 10.7507/1002-1892.20140163 Copy

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2.	董輝, 羅志偉, 張暉, 等. 半側椎板切除治療大型椎管內腫瘤. 云南醫藥, 2012, 33(6):546-548.
3.	Zdeblick TA, Zou D, Warden KE, et al. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am), 1992, 74(1):22-27.
4.	謝京城, 王振宇, 馬長城, 等. 頸椎椎管內腫瘤術后穩定性研究. 中華神經外科雜志, 2008, 24(2):116-119.
5.	Mearini M, Bergomi R, Panciani PP, et al. Dorsal paddle leads implant for spinal cord stimulation through laminotomy with midline structures preservation. Surg Neurol Int, 2012, 3:164.
6.	Bian LG, Bertalanffy H, Sun QF, et al. Intramedullary cavernous malformations:clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg, 2009, 111(6):511-517.
7.	高進苗, 張曉東, 馮春國, 等. 半椎板入路顯微手術在椎管內腫瘤中的臨床應用. 安徽醫科大學學報, 2013, 48(1):94-96.
8.	曹剛, 黃寬明, 張力, 等. 半椎板切除入路顯微手術治療椎管內腫瘤. 中國臨床神經外科雜志, 2013, 18(10):594-598.
9.	Tai CL, Hsieh PH, Chen WP, et al. Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy:An experimental study in porcine model. BMC Muskoloskelet Disord, 2008, 9:84.
10.	Degreif J, Wenda K, Runkel M, et al. Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5):250-255.
11.	劉佐忠, 柯珍勇, 陳亮, 等. 經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折. 中國修復重建外科雜志, 2013, 27(7):824-828.
12.	陳川, 李文勝, 凌聰, 等. 經半椎板入路并椎板復位治療胸椎椎管內腫瘤(附16例報告). 中國臨床神經外科雜志, 2013, 18(1):19-22.
13.	Yao KC, McGirt MJ, Chaichana KL, et al. Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children:an analysis of 161 consecutive cases. J Neurosurg, 2007, 107(6 Suppl):463-468.
14.	Kataria R, Kurmi DJ, Mehta J, et al. Giant lumbosacral schwannoma in a child. J Pediatr Neurosci, 2012, 7(2):126-128.
15.	宗少暉, 王振宇. 單側半椎板"開窗"顯微手術切除頸椎椎管內腫瘤. 中國微創外科雜志, 2005, 5(7):565-566.
16.	劉小波, 林愛國, 唐宏圖, 等. 棘突椎板回植椎管成形術在椎管內腫瘤手術中的應用. 中國臨床神經外科雜志, 2010, 15(4):243-244.
17.	張遠征, 潘隆盛, 喬光宇, 等. 髓內腫瘤切除術中的解剖學復位技術. 中華神經外科雜志, 2009, 25(9):855-856.
18.	包長順, 楊福兵, 劉亮, 等. 后正中入路椎管成形術治療C_1~2椎管腫瘤. 中華神經醫學雜志, 2013, 12(2):137-140.

1. Abul-Kasim K, Thurnher MM, McKeever P, et al. Intradural spinal tumors:current classification and MRI features. Neuroradiology, 2008, 50(4):301-314.
2. 董輝, 羅志偉, 張暉, 等. 半側椎板切除治療大型椎管內腫瘤. 云南醫藥, 2012, 33(6):546-548.
3. Zdeblick TA, Zou D, Warden KE, et al. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am), 1992, 74(1):22-27.
4. 謝京城, 王振宇, 馬長城, 等. 頸椎椎管內腫瘤術后穩定性研究. 中華神經外科雜志, 2008, 24(2):116-119.
5. Mearini M, Bergomi R, Panciani PP, et al. Dorsal paddle leads implant for spinal cord stimulation through laminotomy with midline structures preservation. Surg Neurol Int, 2012, 3:164.
6. Bian LG, Bertalanffy H, Sun QF, et al. Intramedullary cavernous malformations:clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg, 2009, 111(6):511-517.
7. 高進苗, 張曉東, 馮春國, 等. 半椎板入路顯微手術在椎管內腫瘤中的臨床應用. 安徽醫科大學學報, 2013, 48(1):94-96.
8. 曹剛, 黃寬明, 張力, 等. 半椎板切除入路顯微手術治療椎管內腫瘤. 中國臨床神經外科雜志, 2013, 18(10):594-598.
9. Tai CL, Hsieh PH, Chen WP, et al. Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy:An experimental study in porcine model. BMC Muskoloskelet Disord, 2008, 9:84.
10. Degreif J, Wenda K, Runkel M, et al. Rotational stability of the thoracolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5):250-255.
11. 劉佐忠, 柯珍勇, 陳亮, 等. 經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折. 中國修復重建外科雜志, 2013, 27(7):824-828.
12. 陳川, 李文勝, 凌聰, 等. 經半椎板入路并椎板復位治療胸椎椎管內腫瘤(附16例報告). 中國臨床神經外科雜志, 2013, 18(1):19-22.
13. Yao KC, McGirt MJ, Chaichana KL, et al. Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children:an analysis of 161 consecutive cases. J Neurosurg, 2007, 107(6 Suppl):463-468.
14. Kataria R, Kurmi DJ, Mehta J, et al. Giant lumbosacral schwannoma in a child. J Pediatr Neurosci, 2012, 7(2):126-128.
15. 宗少暉, 王振宇. 單側半椎板"開窗"顯微手術切除頸椎椎管內腫瘤. 中國微創外科雜志, 2005, 5(7):565-566.
16. 劉小波, 林愛國, 唐宏圖, 等. 棘突椎板回植椎管成形術在椎管內腫瘤手術中的應用. 中國臨床神經外科雜志, 2010, 15(4):243-244.
17. 張遠征, 潘隆盛, 喬光宇, 等. 髓內腫瘤切除術中的解剖學復位技術. 中華神經外科雜志, 2009, 25(9):855-856.
18. 包長順, 楊福兵, 劉亮, 等. 后正中入路椎管成形術治療C_1~2椎管腫瘤. 中華神經醫學雜志, 2013, 12(2):137-140.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF POSTERIOR MIDLINE APPROACH WITH COMPLETE LAMINECTOMY FOR GIANT INTRASPINAL TUMOR RESECTION AND VERTEBRAL CANAL RECONSTRUCTION

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