Ligament-Saving Laminoplasty for Intraspinal Tumor Excision: A Technical Note

Abstract

Various methods such as laminectomy, laminoplasty, and/or laminotomy can be used to remove intraspinal lesions. However, laminoplasty has generally been known to be able to prevent postoperative instability and deformity and avoid local scarring at operative site. We have described a new laminoplasty technique that can preserve the interspinous ligament during thoracolumbar intraspinal surgery. Ten patients undergoing laminoplastic tumor excision were evaluated preoperatively and postoperatively with neurologic examinations, a pain visual analog scale, and the Oswestry Disability Index. Instability and fusion were evaluated with plain radiography and computed tomography. The operative time, complications, and hospital stay were also assessed. We assessed the data from 10 patients (12 disc levels) with intradural extramedullary tumor who had undergone a ligament-saving laminoplasty procedure. Of the 10 tumors, 6 were schwannoma, 2 were meningioma, 1 was extra-adrenal paraganglioma, and 1 was metastatic adenocarcinoma. Spinal computed tomography was performed 6 months postoperatively. Complete union of the laminoplasty site was achieved for all 10 patients. The flexion-extension view of the plain radiograph was compared with the preoperative images to evaluate the stability of the operated level. No patient had range of motion limitation or instability. Ligament-saving laminoplasty can provide an appropriate surgical view and allow for anatomical reconstruction of the spinal posterior element after excision of spinal cord tumors. This procedure might offer an alternative to classic techniques for selected patients to preserve spinal biomechanical function.