Laminectomy versus laminoplasty in the surgical management of long-segment intradural spinal tumors: Any difference in neurological outcomes?

Abstract

Background:Previous comparative studies have shown that apart from lack of any significant difference in neurologic outcomes between laminoplasty and laminectomy following resection of intradural spinal tumours, spinal column issues such as postoperative deformities, malalignment, and adjacent level disease have also been clearly demonstrated to be quite similar for both techniques. However, there is no study yet that describes any difference in neurologic outcomes for long-segment intradural lesions as a rare subset of these lesions (in terms of number of spinal segments involved) following surgical management between these two techniques.Materials and Methods:This is a retrospective review of surgical treatment with either laminectomy or laminoplasty done for patients with long-segment intradural tumors at a tertiary health-care institution in India.Results:Out of over 167 patients surgically treated for intradural tumors during the study period, a total of 60 patients were included in the evaluation. The long-segment tumors were intramedullary in 22 (36.7%) patients and intradural-extramedullary in the remaining 38 (63.3%) patients. No patient in both cohorts had any revisional surgery after initial resection or any serious complications. The incidence of neurologic function remaining unchanged at the end of follow-up was similar between laminoplasty and laminectomy (12.5% vs. 11.1%). There was no significant correlation between the preoperative McCormick score and postoperative McCormick score (P > 0.05 at 95% degree of confidence; Spearman's rho = 0.028), suggesting that functional outcomes were not dependent on the initial neurologic status. Multivariate logistic regression analysis showed that : the two independent variables (Extent of surgery and Choice of procedure) were not significant predictors of the dependent variable (Functional outcome following surgery) (odds ratio = 3.836; p = 0.071).Conclusion:This retrospective evaluation demonstrates laminoplasty not to be more or less likely to have any better functional outcome or need for revision compared to laminectomy in the resection of long-segment intradural lesions. A quality randomized controlled study on a much larger scale will be required to validate this finding.

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

“…Technical advances in imaging, neuromonitoring, and minimally invasive approaches have been developed for surgery of intradural tumors, aiming to reduce complications and improve functional outcomes (8,9). The real clinical benefits of these new concepts for the treatment of extramedullary lesions remain a matter of debate in the literature (10)(11)(12)(13)(14). Intraoperative neurophysiological monitoring (IONM) could be considered a valid tool to detect in time, during the procedure, the occurrence of a neurological injury, then being able -potentially -to suggest both corrective measures to surgeons and to predict clinical outcomes in a short and long term follow-up (15).…”

“…While for degenerative disease or bone tumors in spine surgery the use of minimally invasive approaches showed to be effective and feasible in multiple examples (23)(24)(25) for IDEM tumors surgery evidence are few. The use of mono lateral laminectomy, indeed, and the use of technological tools such as the Cavitational Ultrasonic Surgical Aspiration (CUSA) should need for further investigations in order to add relevant data and report surgical experiences (13,26,27).…”

Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

“…18,27 Another option is to perform a laminoplasty instead of laminectomy; however, the authors who compared both techniques have found no significant difference between both methods regarding the outcomes. 24 There were some limitations in our study, such as the small number of patients and the short duration of follow-up. We recommend a longer follow-up period to detect the actual rate of recurrence and late drawbacks of surgery such as spinal instability.…”

Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature

“…As reported by Onyia et al, retrospective evaluation in their study demonstrates that laminoplasty not to be more or less likely to have any better functional outcome or need for revision compared to laminectomy in the resection of longsegment intradural lesions. A quality randomized controlled study on a much larger scale will be required to validate this finding [12]. As it has been concluded by Ramesh et al [6] this type of flipped reposition laminoplasty is an excellent technique for the excision of IDEM tumours of the thoracolumbar spine and it provides adequate exposure of spinal canal as well as ad¬ditional stability to spine.…”