Hemilaminectomy approach combined with in situ restoration of vertebral laminae for thoracic intraspinal tumors

Li, Wensheng; Chen, Chuan; Wang, Hui; Liang, Chaofeng; Luo, Lun; Guo, Ying

doi:10.5137/1019-5149.jtn.7859-12.0

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…46 For those lesions affecting the foraminal regions, an additional ipsilateral facetectomy might be required. 13,24 Therefore, in view of the increased risks of spinal instability and deformities associated with these radical operations, especially when the cervical or lumbar spine is operated on, reconstructive fusion procedures are usually required. 15,19,38,39,48 One unique anatomical feature of the lamina of the lumbar spine is its relatively wide wedge-shaped interlaminar space, widest at the center while narrowed at either end.…”

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confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.

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confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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“…The traditional surgical procedures for resection of these pathologies involve subperiosteal muscle stripping, hemilaminectomy, or even extensive laminectomy [5,6]. For lesions that affect the foraminal regions, an additional ipsilateral facetectomy might be required [7]. However, this may necessitate, at least temporarily, external immobilizing, severe and prolonged postoperative pain, risk of late spine instability, and/or kyphosis [8], as well as persistent back pain [9].…”

Section: Introductionmentioning

confidence: 99%

An Analysis of Clinical Efficacy of Microsurgical Resection of Intradural Neoplasm by Unilateral Approach with Caspar Retractors

Wang¹,

Zhao²,

Lei³

et al. 2019

Med Princ Pract

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Significance of the Study• The Caspar distraction device has advantages of smaller wound, less bleeding, fewer postoperative reactions, shorter hospitalization period, and faster recovery. • Exposure of the tumor was not as adequate as that in the standard laminectomy group, especially in the management of ependymoma. • For minimally invasive surgery, preoperative diagnosis is very important, and schwannoma or fibroma with length < 6 cm is the absolute indication for Caspar surgery. AbstractObjective: This study aims to investigate the clinical efficacy of minimally invasive microsurgical resection of intraspinal tumors with the aid of Caspar retractors. Materials and Methods: A total of 125 intraspinal tumor patients with lesions smaller than 6 cm, who were treated at the Neurosurgery Department of our hospital from March 2010 to March 2016, were retrospectively analyzed. Among these, 73 patients underwent microsurgical resection of intraspinal tumors with the aid of Caspar retractors, while 52 patients underwent conventional laminectomy for resection of intraspinal tumors. Relevant indicators between both groups of patients were compared, including length of surgical inci-sion, duration of surgery, postoperative drainage volume, time to first out-of-bed activity after surgery, postoperative hospitalization period, visual analog score (VAS) score, and Japanese Orthopedic Association (JOA) score, at 1 month after surgery. Results: Compared with the conventional laminectomy group, patients who underwent microsurgical resection with the aid of Caspar retractors had better outcomes in terms of length of surgical incision, postoperative drainage volume, time to first out-of-bed activity after surgery, postoperative hospitalization period, and VAS scores (p < 0.05). However, JOA scores at 1 month after surgery did not have any significant differences (p > 0.05). Conclusions:The microsurgical resection of intraspinal tumors with the aid of Caspar retractors has advantages of small trauma, less bleeding, and faster recovery. It is a safe and efficacious method for treating small intraspinal tumors.

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“…[31116] Both tumor invasion and surgical intervention may cause a disruption in the balance of the spine's three-column, predisposing it to disequilibrium and instability. [411] Therefore, pedicle screw placement (PSP) is necessary for these patients to maintain spinal stability. [511] However, there are some difficulties in pedicle screw insertion.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

Jin

Zhao

2016

Chinese Medical Journal

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Background:Although pedicle screw placement (PSP) is a well-established technique for spine surgery, the treatment of patients with primary invasive spinal tumor (PIST) has high surgical risks secondary to destroyed pedicles. Intraoperative three-dimensional fluoroscopy-based navigation (ITFN) system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration. The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods:Fifty-one patients diagnosed with PISTs were retrospectively analyzed, and 157 pedicles screws were implanted in 23 patients using the free-hand technique (free-hand group) and 197 pedicle screws were implanted in 28 patients using the ITFN system (ITFN group). Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP, and McCormick classification was applied for assessment of neurological function. Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results:Of 51 patients, 39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same. In the free-hand group, 145 screws (92.4%) were Grade I, 9 screws (5.7%) were Grade II, and 3 screws (1.9%) were Grade III. In the ITFN group, 192 screws (97.4%) were Grade I, 5 screws (2.6%) were Grade II, and no Grade III screw was detected. Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different (χ2 = 4.981, P = 0.026).Conclusions:The treatments of PISTs include total tumor resection and reconstruction of spine stability. The ITFN system provides a high accuracy of pedicle screw placement.

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Hemilaminectomy approach combined with in situ restoration of vertebral laminae for thoracic intraspinal tumors

Cited by 3 publications

References 25 publications

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

An Analysis of Clinical Efficacy of Microsurgical Resection of Intradural Neoplasm by Unilateral Approach with Caspar Retractors

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

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