Short-term Progressive Spinal Deformity Following Laminoplasty Versus Laminectomy for Resection of Intradural Spinal Tumors: Analysis of 238 Patients

Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Neurosurgery (Impact Factor: 3.62). 05/2010; 66(5):1005-12. DOI: 10.1227/01.NEU.0000367721.73220.C9
Source: PubMed


Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution.
We retrospectively reviewed the records of 238 consecutive patients undergoing resection of intradural tumor at a single institution. The incidence of subsequent progressive kyphosis or scoliosis, perioperative morbidity, and neurological outcome were compared between the LP and LM cohorts.
One hundred eighty patients underwent LM and 58 underwent LP. Patients were 46 +/- 19 years old with median modified McCormick score of 2. Tumors were intramedullary in 102 (43%) and extramedullary in 102 (43%). All baseline clinical, radiographic, and operative variables were similar between the LP and LM cohorts. LP was associated with a decreased mean length of hospitalization (5 vs 7 days; P = .002) and trend of decreased incisional cerebrospinal fluid leak (3% vs 9%; P = .14). Following LP vs LM, 5 (9%) vs 21 (12%) patients developed progressive deformity (P = .728) a mean of 14 months after surgery. The incidence of progressive deformity was also similar between LP vs LM in pediatric patients < 18 years of age (43% vs 36%), with preoperative scoliosis or loss of cervical/lumbar lordosis (28% vs 22%), or with intramedullary tumors (11% vs 11%).
LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.

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    • "Recapping laminoplasty provides a sufficient surgical field and pursues a reconstruction of the whole posterior complex to minimize the impact on postoperative stability. This surgical procedure has been widely used, but currently available literatures talking about recapping laminoplasty are almost always short-term follow-up studies that have demonstrated better clinical outcomes and patient satisfaction [6], [7], [15], [16], [17]. To our best knowledge, no reports have demonstrated the anatomical changes and biomechanical effects of recapping laminoplasty. "
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    ABSTRACT: Background Recapping laminoplasty has become the frequently-used approach to the spinal canal when bone decompression of the vertebral canal is not the goal. However, what changes will occur after surgery, and whether recapping laminoplasty can actually reduce the risk of delayed deformities remains unknown. Methodology We designed an animal experiment using a caprine model, and partitioned the animals into in vitro and in vivo surgical groups. We performed recapping laminoplasty on one group and laminectomy on another group. These animals were sacrificed six months after operating, cervical spines removed, biomechanically tested, and these data were compared to determine whether the recapping laminoplasty technique leads to subsequent differences in range of motion. Image data were also obtained before the surgery and when the animals were killed. Besides, we investigated the initial differences in kinetics between recapping laminoplasty and laminectomy. We did this by comparing data obtained from biomechanical testing of in vitro-performed recapping laminoplasty and laminectomy. Finally, we investigated the effect that longitudinal distance has on cervical mechanics. This was determined by performing a two-level recapping laminoplasty, and then extending the laminoplasty to the next level and repeating the mechanical testing at each step. Principal Findings There were three mainly morphological changes at the six months after laminoplasty: volume reduction and bone nonunion of the recapping laminae, irregular fibrosis formation around the facet joints and re-implanted lamina-ligamentous complex. In the biomechanical test, comparing with laminectomy, recapping laminoplasty didn’t show significant differences in the immediate postoperative comparison, while recapping laminoplasty demonstrated significantly decreased motion in flexion/extension six months later. Inclusion of additional levels in the laminotomy procedure didn’t lead to changes in immediate biomechanics. Conclusions Recapping laminoplasty can’t fully restore the posterior structure, but still reduced the risk of delayed cervical instability in a caprine model.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "Secondly, laminectomy and decompression allowed direct visualization of the posterior vertebral wall for safe cement-filling and removal of cement leakage as soon as it was observed under fluoroscopic monitoring (15). In addition, the use of PMMA cement augmentation helped secure the pedicle screws when pathological fractures or kyphosis developed due to operative instability such as loss of posterior spinal elements (19,20). "
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    ABSTRACT: Multiple myeloma is a fatal hematological malignancy, with the most common localization being the spine. A 72-year-old male patient presented with progressive back pain and dysfunction of ambulation. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) showed spinal cord compression at the T9-T10 level due to an extensive epidural mass in the spinal canal, a large lytic mass of T7-T12 with extraosseous extension and involvement of T9 and T10 vertebral pedicle and posterior wall. The patient underwent posterior spinal decompression and kyphoplasty of T9 and T10 with pedicle screw fixation in T7, T8, T11 and T12. Pain and neural function were improved significantly postoperatively. To our knowledge, such methods have rarely been used to treat a patient with intractable back pain and neurological compromise with multiple myeloma or spinal metastases.
    Full-text · Article · May 2013 · Oncology letters
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    ABSTRACT: Purpose The present study was performed to establish an animal model of cervical kyphosis after laminectomy (C2–C5), and to determine the role of endplate chondrocytes apoptosis in cervical kyphosis after laminectomy. Methods Twenty-four 3-month-old sheep were randomly divided into two groups: the laminectomy group (n = 12), and the control group (n = 12). The cervical spine alignment was evaluated on a lateral cervical spine X-ray using Harrison’s posterior tangent method before surgery and at follow-up. Cartilaginous endplate chondrocyte apoptosis was confirmed using transmission electron microscopy and terminal deoxyribonucleotidyl transferase (TdT)-mediated dUTP nick-end labelling. Results The mean preoperative cervical curvature (C2–5) in the surgery group was −15.8°. The cervical curvature was 19.1° at 3 months post-operation and decreased to 20.2° at the final follow-up postoperatively. The cervical curvature was significantly decreased in the laminectomy group compared with the control group at the last follow-up (P < 0.001), which was a direct indication of kyphotic change. The incidence of apoptotic cells in the surgery group was significantly higher at the 3- and 6-month follow-up than the incidence in the control group. Conclusions The frequency of endplate chondrocyte apoptosis in the laminectomy group was significantly higher than in the control group, indicating that chondrocyte apoptosis may play a pivotal role in the progress of post-laminectomy cervical kyphosis.
    No preview · Article · Jul 2013 · European Spine Journal
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