ABSTRACT
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 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. 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.