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.	董辉, 罗志伟, 张晖, 等. 半侧椎板切除治疗大型椎管内肿瘤. 云南医药, 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.	谢京城, 王振宇, 马长城, 等. 颈椎椎管内肿瘤术后稳定性研究. 中华神经外科杂志, 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.	高进苗, 张晓东, 冯春国, 等. 半椎板入路显微手术在椎管内肿瘤中的临床应用. 安徽医科大学学报, 2013, 48(1):94-96.
8.	曹刚, 黄宽明, 张力, 等. 半椎板切除入路显微手术治疗椎管内肿瘤. 中国临床神经外科杂志, 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.	刘佐忠, 柯珍勇, 陈亮, 等. 经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折. 中国修复重建外科杂志, 2013, 27(7):824-828.
12.	陈川, 李文胜, 凌聪, 等. 经半椎板入路并椎板复位治疗胸椎椎管内肿瘤(附16例报告). 中国临床神经外科杂志, 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.	宗少晖, 王振宇. 单侧半椎板"开窗"显微手术切除颈椎椎管内肿瘤. 中国微创外科杂志, 2005, 5(7):565-566.
16.	刘小波, 林爱国, 唐宏图, 等. 棘突椎板回植椎管成形术在椎管内肿瘤手术中的应用. 中国临床神经外科杂志, 2010, 15(4):243-244.
17.	张远征, 潘隆盛, 乔光宇, 等. 髓内肿瘤切除术中的解剖学复位技术. 中华神经外科杂志, 2009, 25(9):855-856.
18.	包长顺, 杨福兵, 刘亮, 等. 后正中入路椎管成形术治疗C_1~2椎管肿瘤. 中华神经医学杂志, 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. 董辉, 罗志伟, 张晖, 等. 半侧椎板切除治疗大型椎管内肿瘤. 云南医药, 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. 谢京城, 王振宇, 马长城, 等. 颈椎椎管内肿瘤术后稳定性研究. 中华神经外科杂志, 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. 高进苗, 张晓东, 冯春国, 等. 半椎板入路显微手术在椎管内肿瘤中的临床应用. 安徽医科大学学报, 2013, 48(1):94-96.
8. 曹刚, 黄宽明, 张力, 等. 半椎板切除入路显微手术治疗椎管内肿瘤. 中国临床神经外科杂志, 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. 刘佐忠, 柯珍勇, 陈亮, 等. 经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折. 中国修复重建外科杂志, 2013, 27(7):824-828.
12. 陈川, 李文胜, 凌聪, 等. 经半椎板入路并椎板复位治疗胸椎椎管内肿瘤(附16例报告). 中国临床神经外科杂志, 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. 宗少晖, 王振宇. 单侧半椎板"开窗"显微手术切除颈椎椎管内肿瘤. 中国微创外科杂志, 2005, 5(7):565-566.
16. 刘小波, 林爱国, 唐宏图, 等. 棘突椎板回植椎管成形术在椎管内肿瘤手术中的应用. 中国临床神经外科杂志, 2010, 15(4):243-244.
17. 张远征, 潘隆盛, 乔光宇, 等. 髓内肿瘤切除术中的解剖学复位技术. 中华神经外科杂志, 2009, 25(9):855-856.
18. 包长顺, 杨福兵, 刘亮, 等. 后正中入路椎管成形术治疗C_1~2椎管肿瘤. 中华神经医学杂志, 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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