目的：探讨半椎板切开入路切除椎管内肿瘤的优缺点。方法：回顾性分析2004～2006年经手术切除病理证实的椎管内肿瘤196例的临床资料。其中80例行了半椎板入路肿瘤切除，与同期的116例全椎板切除病人进行比较。结果：半椎板切除病人手术住院时间明显缩短，术后起床反应轻微，远期效果较全椎板好，对脊柱的稳定性影响小。结论：单侧半椎板入路切除椎管内肿瘤损伤小，最有利于脊柱稳定性的维持。病人手术后住院时间短，反应轻微，远期疗效好。但也有暴露局限的缺点.
ObjectiveTo 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. MethodsBetween 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. ResultsPostoperative 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). ConclusionThe 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.
ObjectiveTo 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. MethodsA 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 T5,6 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. ResultsAfter 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. ConclusionThe 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.
ObjectiveTo investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal.MethodsThe clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score.ResultsThe operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value (t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value (t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%.ConclusionModified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.
ObjectiveTo evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae. MethodsThe clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C1 and C2. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded. Results The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores (P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation (P>0.05). ConclusionThe treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.