Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients

Abstract

ObjectiveWe report our experience with the use of hemilaminectomy approach for the removal of benign intraspinal tumors.MethodA retrospective review of 1,067 patients who underwent hemilaminectomy in our hospital between 2013 and 2019 was analyzed. Baseline medical data were collected. One hundred sixteen patients were excluded due to degenerative diseases, spinal bone tumors, and malignant tumors. The remaining 901 patients (916 tumors) were enrolled. The Dennis Pain Scale (DPS) was used to assess improvement in pain before surgery and during long-term follow-up. Neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale.ResultsThe age of the patients was 48.7 ± 15.3 years, the duration of symptoms was 16.5 ± 32.0 months, and the tumor size was 2.6 ± 1.4 cm. Three hundred two tumors were located in the cervical region, 42 in the cervicothoracic region, 234 in the thoracic region, 57 in the thoracolumbar region, and 281 in the lumbar and lumbosacral region. Twenty-three tumors were ventrally located, 677 were dorsal or dorsolateral, 63 were intramedullary, 87 were epidural, and the rest were dumbbell-shaped. The most common pathologies were schwannomas (601, 66.7%) and meningiomas (172, 19.1%). Total excision was achieved at 97.8%. The operative time was 94.3 ± 32.6 min and the blood loss during surgery was 96.9 ± 116.5 ml. The symptom of pain improved in 87.0% of patients during long-term follow-up, neurological function improved in 68.3% and remained unchanged at 30.5%.ConclusionThe hemilaminectomy approach was a rapid and safe procedure to remove intradural and extradural tumors. This approach has offered several advantages. It could be used for the resection of most extradural or intradural extramedullary lesions, even some intramedullary tumors.

A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas

“…Cutting the dentate ligament and rotation of operating table enable a better visualization of the tumor. 7,18 A case series by Onken et al demonstrated also similar EOR in anterior SM in comparison with dorsal ones, 8 unilateral hemilaminectomy can also be used in more difficult cases with calcified meningiomas. 42 This approach is much less invasive than alternative approaches to ventrally located meningiomas, as previously described.…”

“…Our results are in line with several previous studies. 6-8 In the past, one study has reported contrary results. 15 Goodarzi et al presented their findings, wherein they compared the 2 different approaches and observed a lower rate GTR when using a unilateral approach.…”

“…[1][2][3][4][5] Conventionally, laminectomy has been the preferred approach; however, the emergence of unilateral hemilaminectomy as a less invasive alternative has gained traction in recent years. [6][7][8][9] Unilateral hemilaminectomy involves minimal bone removal and muscle detachment from only one side, aiming to achieve comparable or even superior postoperative results through reduced surgical impact, decreased pain, quicker recovery, and improved long-term outcomes, such as prevention of postlaminectomy kyphosis. [10][11][12] The adoption of minimal invasive spine surgery has been growing steadily with advancements in technology and enhanced surgical training, 13,14 yet its applicability in the context of spinal intradural tumor resection remains a subject of controversy.…”

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment

“…Moreover, previous publications comparing both approaches show significantly less blood loss and lower LOS [11]. More invasive surgical approaches do not seem to be required in most cases, even in ventral located and calcified meningiomas [11,27,39,40], and other intradural tumors [41]. Furthermore, minimal invasive unilateral approaches seem to play a role in preventing CSF leakage, one of the more frequent possible complications of after surgery on intra-dural pathologies [20,22,42,43].…”

Convolutional neural network-based magnetic resonance image differentiation of filum terminale ependymomas from schwannomas

“…With the development and popularity of minimally invasive neurosurgery, most intraspinal tumours can be removed through microforaminotomy [ 4 ] after piecemeal resection (removing the tumour in small pieces), which may increase the risk of tumour metastasis in some tumours, such as ependymomas. Ependymomas are prone to spread in the spinal canal during surgery [ 5 – 7 ], and the total laminectomy approach is preferred.…”