Comparative Study of the Unilateral Hemilaminectomy Approach and the Total Laminectomy Approach in the Treatment of Subdural Extr-amedullary Tumors / 医学研究杂志

Objective To compare the clinical results of the unilateral hemilaminectomy approach and the total laminectomy ap-proach in the treatment of subdural extramedullary tumors.Methods One hundred cases with subdural extramedullary tumors from Sep-tember 2010 to September 2013 in the General Hospital of Ningxia Med.Univ.underwent surgery intervention were prospective analyzed. Among them,50 cases( the observation group) received tumor resection by the unilateral hemilaminectomy approach,and another 50 cases ( the control group) received the treatment by the total laminectomy approach.All received electrophysiological monitoring in the opera-tion.Operation time,intraoperative bleeding,postoperative hospitalization duration and postoperative recurrence rate in 6 months to 1 year etc.were recorded and compared.Results Operation time,intraoperative bleeding,postoperative hospitalization duration and postoperative fields time in the the observation group were less than the control group(P<0.05).There was no significant difference in curative effect aspects.In the postoperative follow-up(6 months to 1 year) ,the spinal instability cases in the observation group(0 case) was significantly less than the control group (6 cases).Conclusion Compared with the total laminectomy approach,the unilateral hemilaminectomy ap-proach in the treatment of subdural extramedullary tumors has more advantages as follows:better curative effect, smaller trauma, quicker recovery, fewer complications, great maintenance in spinal mobility and stability etc.

Radiographic Changes of Adjacent Upper Segment Performed Short Segmental Lumbosacral Fusion: Does Total Laminectomy Influence Adjacent Upper Segmental Instability? / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to compare factors that influence degenerative changes in patients undergoing total laminectomy and patients undergoing partial laminectomy. SUMMARY OF LITERATURE REVIEW: Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent segment problems of the upper segment. However, the differences between the two procedures that may influence adjacent segment instability are still controversial. MATERIALS AND METHODS: We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (at most 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment procedures included total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the intervertebral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and last follow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation. However, we included cases that required revision due to adjacent segmental problems during the follow-up period. RESULTS: The mean age of the patients treated with total laminectomy was 59.0+/-10.9 years, and of the patients treated with partial laminectomy was 58.8+/-10.2 years. The preoperative Thompson grade showed no statistical difference. The difference in disc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical difference between the two groups. CONCLUSIONS: There was no significant difference in the radiographic or clinical outcomes based on removal or preservation of posterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.

Post-Laminectomy Kyphosis in Patients with Cervical Ossification of the Posterior Longitudinal Ligament: Does It Cause Neurological Deterioration?

OBJECTIVE: Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status. METHODS: We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated. RESULTS: The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0.002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae. CONCLUSION: Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.

Spinal Extradural Arachnoid Cyst: Case Report

We report a case of thoracolumbar extradural arachnoid cyst in a 39-year-old male who presented with left lower thoracolumbar back pain, left buttock pain, hypesthesia in the left leg for three months. Magnetic resonance image revealed a cystic mass which lies posterior to the spinal cord from T12 to L2 vertebra level. The spinal cord was displaced anteriorly and flattened. We performed total laminectomy from lower half of T12 to upper half of L2 to remove cystic mass which was found to be an extradural lesion. There was a dural opening near the left L1 nerve root sleeve through which cerebrospinal fluid(CSF) was leaking and part of nerve roots were moving back and forth by CSF pulsation. A prompt improvement of the symptoms was noted after surgery. Possible mechanisms of spinal extradural arachnoid cyst and surgical intervention are discussed.

Thoracolumbar Intramedullary Astrocytoma of the Spinal Cord: Report of 1 Case

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.

Ewing's Sarcoma of the Thoracic Spine Associated with Paraplegia: Report of 1 case

Since Ewing has reported a primary malignant tumor as medullary origin in 1921, the Ewing's sarcomas have been reported more than 1,000 cases in the literatures. The Ewing's sarcoma has frequent incidence in the long tubular bone but very rare in the skull and spine for primary malignant tumor of the bone. The incidence of the Ewing's sarcoma in the spine is very rare than in the skull. We experienced a case of Ewing's sarcoma of the thoracic spine which has associated a paraplegia as neurological deficit. A 24 years old Korean female has admitted to our clinical because of paraplegia with incontinence for 2 days. On admission, the neurological examination revealed a paraparesis below T3 level with urinary and fecal incontinence, and then local tenderness on T2 level. No fever and leucocystosis were checked. Only the ESR has elevated up to 38 mm/hr. The simple X-ray film of the thoracic spine has showed a mottled destruction of the T2 vertebral body and abscence of the pedicle shadow, which were more similar to the picture of malignant tumor(primary or metastatic) than the bony change of ostemyelitis. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion. We found a complete block at T2 level by myelography. Then the immediate total laminectomy on T2-3 was applied. The operative finding was a extradural mass, which has compressed the spinal cord. We removed the tumor mass incompletely but the decompression was enough. The neurologic deficit has improved gradually for post-operative 2 weeks, but the improvement of neurologic deficit has stopped to T10 sensory recovery. We performed a radiation therapy as 4500 rads dose for 4 weeks, but not further improvement has been found. The post-operative pathological diagnosis was Ewing's sarcoma as a anaplastic small cell type.