APPLICATION OF POSTERIOR SPINAL CANAL RECONSTRUCTION IN SURGERY OF INTRASPINAL TUMOR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YEQing , HUANGWu , HEYunsong , NONGMingshan , LIANGTiansen , TANSuzhen , YANGXing

Department of Orthopedics, General Hospital of Guangxi Armed Police, Nanning Guangxi, 530003, P. R. China;

Corresponding?author：

YEQing, Email: yqys2003@163.com

Keywords：

Intraspinal tumor; Laminoplasty; Posterior spinal canal reconstruction

DOI：

10.7507/1002-1892.20140212

Video：

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Objective To apply H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumors,and observe its effectiveness. Methods A total of 48 cases of thoracic and lumbar intraspinal tumors were recruited between February 2006 and May 2012,including 35 males and 13 females with a mean age of 29.5 years (range,17-48 years).The disease duration was 3-16 months (mean,10.5 months).Intraspinal tumors located at T_5,6 in 3 cases,at T₁₀ in 7 cases,at T₁₂,L₁ in 13 cases,at L₃ in 10 cases,and at L₄-S₁ in 15 cases.There were 18 cases of epidural meningioma,2 cases of epidural lipoma,3 cases of extramedullary neurological tumors,10 cases of extramedullary meningioma,6 cases of extramedullary schwannoma,6 cases of intramedullary ependymoma,and 3 cases of intramedullary astrocytoma.All patients underwent H-shaped allogeneic bone graft combined with spinous process replantation for posterior spinal canal reconstruction after removal of intraspinal tumor by posterior laminectomy.The Oswestry disability index (ODI) was used to assess postoperative symptom improvement,and the Frankel grade of spinal cord injury to evaluate the extent of nerve damage and recovery. Results After operation,8 cases had cerebrospinal fluid leakage,and 4 cases had yellowish exudate,and they were all cured after appropriate treatment; primary healing of wound was obtained in the other cases,without postoperative complication.Forty-eight patients were followed up 18-72 months (mean,38 months).CT showed all the graft bones healed and posterior spinal canal was well reconstructed without iatrogenic spinal stenosis formation.X-ray film showed no vertebral instability or spondylolisthesis,and no shifting of reconstructed vertebrae.MRI showed no recurrence except 1 case.The symptoms were improved significantly after operation; the ODI score at last follow-up (16.69±2.53) was significantly lower (t=0.89,P=0.00) than that at preoperation (47.83±7.25).The results of symptom improvement were excellent in 36 cases,good in 10 cases,fair in 1 case,and poor in 1 case; the excellent and good rate was 95.83%.At last follow-up,Frankel grade was improved significantly (Z=13.32,P=0.00) when compared with preoperative grade except 1 recurrent patient. Conclusion The application of the H-shaped allogeneic bone graft combined with spinous process replantation can well reconstruct the posterior spinal canal,and also can effectively avoid iatrogenic spinal stenosis,so it is worthy of promoting in the clinical treatment of intraspinal tumor surgery.

Citation： YEQing, HUANGWu, HEYunsong, NONGMingshan, LIANGTiansen, TANSuzhen, YANGXing. APPLICATION OF POSTERIOR SPINAL CANAL RECONSTRUCTION IN SURGERY OF INTRASPINAL TUMOR. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 965-968. doi: 10.7507/1002-1892.20140212 Copy

1.	黃凱,謝大志,龍耀武,等.原發性椎管內腫瘤的診斷和手術治療.吉林醫學,2009,30(13):1315-1316.
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10.	楊榮利,曲華毅,燕太強,等.肩胛下經胸入路切除及重建治療上胸椎腫瘤.中華外科雜志,2008,46(19):1486-1489.
11.	Ostelo RW,Deyo RA,Stratford P,et al.Interpreting change Scores for pain and functional status in low back pain:towards international consensus regarding minimal important change.Spine (Phila Pa 1976),2008,33(1):90-94.
12.	Banczerowski P,Vajda J,Veres R.Removal of intraspinal space-occupying lesions through unilateral partial approach,the "hemi-semi lam inectomy".Ideggyogy Sz,2008,61(3-4):114-122.
13.	Kato Y,Kaneko K,Kataoka H,et al.Cervical hemilaminoplasty:technical note.J Spinal Disord Tech,2007,20(4):296-301.
14.	唐欣,楊述華,余從年,等.同種異體凍干輻照骨板在椎管重建過程中的應用.山東醫藥,2006,46(23):8-10.
15.	蔣電明,權正學,黃偉,等.納米羥基磷灰石/聚酰胺66復合生物活性人工椎板的初步臨床應用.中國修復重建外科雜志,2007,21(5):441-444.
16.	Lv C,Zhou Z,Song Y,et al.Novel biodegradable lamina for lamina repair and reconstruction.Spine J,2013,13(12):1912-1920.
17.	Fritsh EW,Heisiel J,Roupp S.The failed back surgery syndrome:reasons,a report of 182 operative treatments.Spine (Phila Pa 1976),1996,21(5):626-633.
18.	Le Corre M,Lonjon G,Khouri K,et al.Giant spinal schwannoma:complete excision and one-step posterior spinal reconstruction.Spine J,2012,12(11):1075-1076.
19.	徐輝,肖嵩華,劉鄭生,等.胸腰椎轉移瘤的外科治療策略和效果分析.中國骨傷,2014,27(1):25-28.

1. 黃凱,謝大志,龍耀武,等.原發性椎管內腫瘤的診斷和手術治療.吉林醫學,2009,30(13):1315-1316.
2. 周強,陳德玉,史建剛,等.髓外硬膜下腫瘤的手術治療與臨床效果.中國矯形外科雜志,2009,17(7):485-487.
3. 謝京城,王振宇,馬長城,等.660例椎管內腫瘤的手術治療.中國微創外科雜志,2009,9(10):940-945.
4. 曹治東,李邦春.椎板切除術后硬膜外瘢痕粘連發生機制及預防研究進展.重慶醫學,2012,11(21):2207-2209.
5. Rabb CH.Failed back syndrome and epidural fibrosis.Spine J,2010,10(5):454-455.
6. Abeloos L,De Witte O,Riquet R,et al.Long-term outcome of patients treated with spinal cord stimulation for therapeutically refractory failed back surgery syndrome:a retrospective study.Neurochirurgie,2011,57(3):114-119.
7. Raffaeli W,Righetti D,Andruccioli J,et al.Periduroscopy:generalreview of clinical features and development of operative models.Acta Neurochir Suppl,2011,108:55-65.
8. 王智運,章凱,許俊杰,等.棘突椎板回植內固定術重建腰椎后柱結構的早期臨床研究.中國修復重建外科雜志,2011,25(10):1276-1278.
9. 劉洪泉,孫印臣,王立忠,等.半椎板入路椎管內腫瘤顯微切除術.中華神經外科雜志,2006,22(8):503-505.
10. 楊榮利,曲華毅,燕太強,等.肩胛下經胸入路切除及重建治療上胸椎腫瘤.中華外科雜志,2008,46(19):1486-1489.
11. Ostelo RW,Deyo RA,Stratford P,et al.Interpreting change Scores for pain and functional status in low back pain:towards international consensus regarding minimal important change.Spine (Phila Pa 1976),2008,33(1):90-94.
12. Banczerowski P,Vajda J,Veres R.Removal of intraspinal space-occupying lesions through unilateral partial approach,the "hemi-semi lam inectomy".Ideggyogy Sz,2008,61(3-4):114-122.
13. Kato Y,Kaneko K,Kataoka H,et al.Cervical hemilaminoplasty:technical note.J Spinal Disord Tech,2007,20(4):296-301.
14. 唐欣,楊述華,余從年,等.同種異體凍干輻照骨板在椎管重建過程中的應用.山東醫藥,2006,46(23):8-10.
15. 蔣電明,權正學,黃偉,等.納米羥基磷灰石/聚酰胺66復合生物活性人工椎板的初步臨床應用.中國修復重建外科雜志,2007,21(5):441-444.
16. Lv C,Zhou Z,Song Y,et al.Novel biodegradable lamina for lamina repair and reconstruction.Spine J,2013,13(12):1912-1920.
17. Fritsh EW,Heisiel J,Roupp S.The failed back surgery syndrome:reasons,a report of 182 operative treatments.Spine (Phila Pa 1976),1996,21(5):626-633.
18. Le Corre M,Lonjon G,Khouri K,et al.Giant spinal schwannoma:complete excision and one-step posterior spinal reconstruction.Spine J,2012,12(11):1075-1076.
19. 徐輝,肖嵩華,劉鄭生,等.胸腰椎轉移瘤的外科治療策略和效果分析.中國骨傷,2014,27(1):25-28.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF POSTERIOR SPINAL CANAL RECONSTRUCTION IN SURGERY OF INTRASPINAL TUMOR

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