Retrospective observational comparative study of Hemilaminectomy versus Laminectomy for intraspinal tumour resection; Shorter Stays, Lower Analgesic Usage and Less Kyphotic Deformity.

INTRODUCTION: Intraspinal tumours are rare and principally managed surgically. Laminectomy, employed for access to the spinal canal, destroys the posterior tension band leading to a risk of kyphosis. Hemilaminectomy as an alternative may be less destructive, potentially reducing the risk of deformity and causing less post-operative pain. METHOD: We investigated this hypothesis by retrospectively reviewing a case series of 56 surgeries for a disparate and unselected group of intraspinal tumours utilizing a laminectomy or hemilaminectomy approach. RESULTS: No difference was found in length of operation, completeness of resection, complication rate and Frankel-score improvements. Hemilaminectomy (n = 22) is associated with reduced hospital stay (post-op days) 4.5 (2-6) versus 6 (3-8), (p = 0.026, Mann-Whitney), and a reduction in post-operative morphine use (mg) 10 (3.5-28) versus 30 (10-90), (p = 0.005, Mann-Whitney). Post-operative kyphosis was measured with the Harrison posterior tangent method on T2-weighted sagittal MR images. The average change in kyphosis angle was greater in the laminectomy group compared with the hemilaminectomy group, 3.6 (0.8-6.2) versus 0.4 (-0.2-1.2), statistically significant (p = 0.004, Mann-Whitney). CONCLUSION: Hemilaminectomy is as effective an access procedure for the resection of unselected intraspinal tumours as laminectomy, but is associated with shorter post-operative stays, lower analgesic requirements and less post-operative kyphosis.

Mono-segment fixation of thoracolumbar burst fractures.

OBJECT: To investigate what benefits can be derived from a shorter construct length in the pedicle screw based surgical treatment of thoracolumbar burst fracture (TLBF). METHODS: A retrospective analysis was performed of clinical notes and radiology for patients who underwent surgical fixation of TLBFs between 2007 and 2012 in a single UK institution. Constructs either fixed the vertebra above the fracture to the vertebra below (short segment fixation - SSF) or fixed the vertebra above to the relatively well-preserved pedicles and inferolateral portions of the bodies of the fractured vertebra (mono-segment fixation - MSF). 11 patients in each group were included and length of operation, postoperative opiate use, time to mobilisation and length of hospital stay were recorded. Anterior vertebral height loss (AVHL) was measured from sagittal reconstructions of CT imaging and lateral radiographs. RESULTS: The mean operation time was 169 ± 10.4 min in the MSF group compared to 227 ± 13.3 minin the SSF group (p = 0.0028). Mean postoperative opiate use was 50.4 ± 17.9 mg in the MSF group compared to 126.6 ± 64.6 mgs in the SSF group (p = 0.3088, ns). Mean time to mobilisation was 1.3 ± 0.2 in the MSF group and 3.4 ± 1.3 in the SSF group (p = 0.1031, ns). There were no significant differences in progression of anterior vertebral height loss or hospital stay between the two groups. CONCLUSIONS: MSF for TLBFs is associated with shorter operative times than SSF. Strong trends are also demonstrated to quicker mobilisation, and lower opiate use. These advantages of a shorter construct length may result in cost saving and echo the advantages claimed by others for reducing spinal exposure in minimally invasive spinal surgery.