Hemilaminectomy Research Articles

Functional outcome after introduction of hemilaminectomy in management of spinal schwannomas and meningiomas

BackgroundSchwannomas and meningiomas are intradural extramedullary spinal tumors which are regularly encountered in the neurosurgical clinic. These tumors cause neurological deficit by compression on the spinal cord and commonly pain when affecting the cauda equina. The traditional treatment with standard laminectomy (SL) can cause instability to the dorsal segments of the spinal column, and the less invasive option of hemilaminectomy (HL) has therefore been developed. We aim in this study to investigate transition from SL to HL in a population-based cohort. MethodsAdult patients (18 years and older) undergoing primary surgery due to spinal meningioma or schwannoma between 2007 and 2022 at the neurosurgical clinic were included. Data related to clinical, surgical and outcome variables were retrospectively collected. ResultsA total of 187 patients were identified: 155 in the SL group, 26 in the HL group and in 6 patients a combination of SL and HL. The mean age of the SL group was 62.7 years (SD14.2) compared to 58.0 (SD15.7) in the HL group (p = 0.16). Preoperative motor deficit was more common in SL group compared to HL group (76.8 % and 61.5 %, respectively, p = 0.14). Thoracal location was most common for both groups (SL 65.8 % and HL 61.5 %). Postoperative change in McCormick grades and early complications were similar between groups. ConclusionOutcome after hemilaminectomy due to intradural extramedullary schwannoma or meningioma is comparable to standard laminectomy with regards to postoperative complications and neurological improvement. Our findings support the transition to hemilaminectomy in selected cases.

P119. Comparison of five-year outcomes between wide laminectomy, segmental bilateral laminotomies and unilateral hemi-laminectomy for lumbar spinal stenosis

BACKGROUND CONTEXT The optimal procedure for lumbar spinal stenosis remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy and laminectomy with instrumented fusion. PURPOSE To report on outcomes in lumbar spinal stenosis patients who underwent wide laminectomy, segmental bilateral laminotomy or unilateral hemilaminectomy. STUDY DESIGN/SETTING Retrospective review of patients prospectively enrolled in Danespine. PATIENT SAMPLE Patients with LSS underwent wide laminectomy, segmental bilateral laminotomy or unilateral hemilaminectomy with five-year outcomes data. OUTCOME MEASURES Oswestry Disability Index (ODI), Reoperation rate. METHODS Patients with spinal stenosis who were enrolled in the DaneSpine database from January 2010 until May 2014 and underwent wide laminectomy, segmental bilateral laminotomy or unilateral hemilaminectomy were identified. Patients completed standard questionnaires preoperatively and 1, 2 and 5 years after surgery that included the Oswestry Disability Index (ODI). Perioperative data, including ASA score, body mass index and smoking status were also collected. RESULTS A total of 510 patients (265 males and 245 females) were included. Most patients were operated with segmental bilateral laminectomy over one level (n=283). Operative method (p=0.07) was not found to be a predictor for patients achieving MCID for ODI (12-point change) from baseline to 1, 2 and 5 years follow-up. ASA score (p=0.036) and smoking status (p=0.015) were associated with change in ODI above MCID after one and two year. Twenty-eight patients were reoperated on same level after primary decompression alone, either because of disc prolapse (n=3), dural tear (n=3), re-decompression (n=17), hematoma (n=4) or fusion (n=1). We did not find reoperation to be associated with operative method (p=0.60), although age at operation time seems to predict reoperation (p=0.039). CONCLUSIONS There is no difference in MCID change in ODI with either broad laminectomy, segmental bilateral laminotomy or unilateral hemi laminectomy after 1, 2 and 5 years. Factors associated with achieving ODI MCID were smoking status and ASA score at 1 and 2 years of follow-up but without significant difference at 5 years postop. Age at surgery was found to predict risk of reoperation after 5 years. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Lumbar spine chordoma in adolescent: Case report.

Chordoma is a rare slow-growing neoplasm that arises from primitive notochordal remnants with a high rate of recurrence. It can occur anywhere within the spine or the base of the skull. Chordoma involving lumbar spine are rare, approximately 6% of spinal chordomas originate in the lumbar vertebrae. Prognosis is better than adults and depends on the extent of surgical resection, age and histology subgroup. We report a case with solitary L2/L3 vertebral body lesion causing caudal compression and bilateral lower limb weakness treated with L2/L3 right hemi laminectomy and tumor decompression.

Clinical application of para-split laminotomy in the treatment of lumbar spinal canal tumors

Objective To explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar spinal canal tumors. Methods We retrospectively reviewed the clinical data of 15 patients with lumbar spinal canal tumors who underwent tumor resection following para-split laminotomy at Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to May 2018. Observation indicators included intraoperative blood loss, surgical duration, tumor resection, tumor pathological results and complications.Neurological functions of the spinal cord evaluated based on JOA (Japanese Orthopedic Association) scoring system. The follow-up situations included tumor recurrence, spinal stability evaluation and bone fusion of laminae. Results All lumbar spinal canal tumors were resected completely. The mean blood loss was 95.3±58.2 ml and the mean duration of the surgical procedure was 176.7±35.2 min. In this group, the average preoperative JOA score was 15.5±4.9 and the average postoperative JOA score was 24.0±3.5, which was improved significantly (P<0.01). There were no operative complications occurring. The CT examination showed no pedicle or vertebral fractures. During the follow-up period of 6-18 months (average: 10.8±3.9 months), no tumor recurrence or spinal deformation was found according to the imaging examination. CT examination showed that the split laminae tended to heal in the operative area. Conclusion The para-split laminotomy shows minimally invasive damage to the posterior spinal tension band and helps to protect the stability of the spine. It is feasible and effective to apply the para-split laminotomy in the operation of lumbar spinal canal tumors. Key words: Spinal canal; Neoplasms; Neurosurgical procedures; Laminotomy

Early efficacy of endoscopic laminectomy and traditional hemilaminectomy for lumbar spinal stenosis

Objective To compare the clinical effects of endoscopic laminectomy with traditional hemilaminectomy for lumbar spinal stenosis. Methods From January 2016 to April 2017, 61 patients with lumbar spinal stenosis were treated surgi-cally. Percutaneous endoscopic laminectomy was performed in 32 patients (minimally invasive group), including 13 males and 19 females, aged 38-76 years, with an average age of 58.47±7.51 years. Twenty-nine patients (open group) underwent hemilaminecto-my, including 11 males and 18 females, aged 38-75 years, with an average age of 57.17±9.99 years. The operation time, bleeding, incision length, bedridden time and hospitalization time were recorded. Visual analogue scale(VAS), Oswestry disability index (ODI), dural sac cross-sectional area (DSCA), ventral intervertebral space height (VH), dorsal intervertebral space height (DH) and lumbar mobility (range of motion, ROM) were compared between the two groups. Results All of 61 patients were followed up for 14 to 27 months, with an average of 19.2±2.95 months. The operation time was 60.88±6.49 min in the minimally invasive group, and 52.07±9.45 min in the open group (t=4.277, P=0.000). The blood loss of minimally invasive group was 55.63±10.14 ml, and that of open group was 78.79±12.58 ml (t=7.952, P=0.000). The incision length of minimally invasive group was 23.31±4.56 mm, and open group 82.59±7.66 mm (t=12.047, P=0.000). Bed rest time was 21.97±6.42 h in minimally invasive group and 78.79±12.58 h in open group (t=12.047, P=0.000). The hospitalization time of the minimally invasive group was 8.53±2.75 d and the open group 11.34±3.12 d (t=3.745, P=0.000). All these parameters had statistical significance (P<0.05). At the last follow-up, the VAS score of minimally invasive group was 1.06±0.56, and the open group was 1.14±0.74 (t=0.469, P=0.634). ROM of open group was 5.66±1.12 degree, and ROM of minimally invasive group was 5.56±1.13 degree (t=0.140, P=0.710), VH of minimally invasive group was 14.75±2.81 mm, and open group was 14.44±2.89 mm (t=0.181, P=0.672). There was no significant difference between the two groups for these parameters. At the last follow-up, ODI score was 13.25%±1.08% in the minimally invasive group and 14.28%±2.10% in open group (t=5.911, P=0.018). DSCA score was 108.56±8.69 mm2 in the minimally invasive group, and 117.28±11.09 mm2 in open group (t=11.774, P=0.001). There were significant differences between the two groups for ODI and DS-CA. Conclusion Both endoscopic and open laminectomy have excellent clinical effects on lumbar spinal stenosis. Endoscop-ic laminectomy has the advantages of less local trauma, less damage to the stability of the lumbar spine and faster recovery. However, there's a higher technical requirement for endoscopic spine surgery. Key words: Lumbar vertebrae; Spinal stenosis; Laminectomy; Video-assisted surgery; Surgical procedures, minimally in-vasive

Comparative study between functional outcome of lumbar canal stenosis treated with surgical decompression by laminectomy and unilateral partial hemi laminectomy approaches

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lumbar spinal canal stenosis may eventually cause signs of intermittent neurogenic claudication&lt;strong&gt;. &lt;/strong&gt;The surgical options include procedures such as midline decompression by laminectomy and different kinds of unilateral and bilateral fenestrations and partial or full hemi laminectomies. The aim of the study is to unilateral decompressive approach provides the sufficient decompression; less invasive unilateral procedure, which preserves posterior musculoligamentous complex and bony structures reduce associated morbidity.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 41 patients underwent preoperative assessment of Japanese orthopaedic association score (JOA Score), Neurogenic claudication outcome scores (NCOS), visual analogy scale for back pain and neurogenic claudication. Patients were randomized to undergo either unilateral decompression by partial hemi laminectomy or CMD (CMD) by laminectomy. 20 patients was randomized into unilateral decompression by partial hemi laminectomy group and 21 patients into CMD (CMD) by laminectomy group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean JOA recovery rate was 50.61% for the unilateral decompression group and 52.12% for the CMD group. Notably, 62% of CMD group had good or excellent outcome while 70% of unilateral decompression group had a good or excellent outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study, unilateral decompression by a partial hemi laminectomy provides minimal exposure for decompression in lumbar canal stenosis while preserving musculoligamentous attachments of the posterior elements of the spine and good postoperative results after one year with favorable outcomes of at least 70%. &lt;/p&gt;

The application of laminotomy and titanium plate internal fixation in surgery of children’s space-occupying lesions within the vertebral canal

Objective To explore the clinical effects of laminotomy and titanium plate internal fixation in surgery of children’s space-occupying lesions (SOL) in the vertebral canal. Methods A retrospective analysis was conducted about 87 patients with SOL in the vertebral canal who underwent laminotomy and titanium plate internal fixation at Neurosurgery Department of Zhengzhou Children's Hospital from January 2010 to January 2013. The patients’ ages ranged from 0.5 to 9.0 years old with an average of 4.7±1.9 years old. The symptoms were assessed according to the modified McCormick grading system and the spine stability was assessed based on the imaging results. Results For all 87 patients, laminotomy was performed at 2-7 vertebral segments with an average of 4±2 segments. The operation duration was 60-135 min with an average of 111±15 min. Total resection of lesions was achieved in 77 cases (88.5%) and partial resection in 10 cases (11.5%). No spinal nerve injury related to titanium plate fixation or focal effusion occurred post operation. The patients were followed up for 12-36 months with an average of 26.1±4.9 months and no symptomatic aggravation was reported post operation. Preoperative McCormick grades Ⅰ-Ⅴ were reported in 10, 16, 21, 34 and 6 cases, respectively. Postoperative grades Ⅰ-Ⅴ were decided to be in 44, 29, 7, 5 and 2 cases, respectively. Imaging studies at follow-up showed that the local titanium plates were fixed well without fracture, collapse, displacement, and no stenosis, lateral convexity, posterior convex deformity or spinal instability was reported. Conclusions The procedures of laminotomy and titanium plate internal fixation could not only facilitate exposure of lesions, but also help reconstruct anatomical structure of the spinal canal and maintain the spinal stability, which seem to demonstrate simplicity, safety and efficacy. Key words: Vertebral canal space-occupying lesions; Laminotomy; Vertebral canal reconstruction; Child

Mobile C-arm CT scan in surgery for thoracolumbar burst fractures of type A3

Objective To discuss the application of mobile C-arm CT scan in the operations for thora-columbar burst fractures of type A3. Methods From January 2012 to December 2014, 21 patients with sin-gle-segment thoracolumbar burst fracture (AO type A3) were treated. They were 15 males and 6 females, aged from 17 to 68 years (average, 43.6 years). By the American Spinal Injury Association (ASIA) grading, one was grade A, 2 were grade B, 12 grade C, 4 grade D and 2 grade E. Preoperative CT examination was conducted. Mobile C-arm CT scan was performed to evaluate reduction of the fragments after the fracture was reset by posterior pedicle screwing. Laminotomy for canal decompression or reduction of the fragments would be performed if it was indicated by the results of mobile C-arm CT scan. CT examination was conducted postoperatively to assess the fracture re-duction and recovery of the canal calibre. Results All the patients were followed up for an average of 15.5 months (from 10 to 18 months). Their cobb angle, vertebral anterior margin compression rate, spinal occupancy rate, vertebral translocation rate and visual analogue score at postoperation and final follow-up were significantly improved compared with their preoperative values (P 0.05). Postoperative ASIA grading showed that the spinal function was improved from grade B to grade C in one, from grade C to grade D in 4 cases, from grade C to grade E in 5 cases, and from grade D to grade E in 3 cases. Conclusion Since intraoperative C-arm CT scan can help decide whether laminectomy for canal decompression is conducted or not in the surgery of thoracolumbar burst fractures, it enhances the surgical safety and reliability. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures,bone; Fracture fixation,internal; C-arm CT

Post-discectomy pseudocyst after transformimal percutaneous endoscopic discectomy: two cases reports and related literature review

Objective To investigate the clinical features and treatment of post-discectomy pseudocyst after transformimal percutaneous endoscopic discectomy. Methods Two patients from two different hospitals were retrospectively studied. One was male whose age was 26 years old, and the other was female whose age was 34 years old. Both cases presented with radiating unilateral leg pain and were diagnosed with ipsilateral herniated nucleus pulposus at L4,5 based on MRI. They both experienced recurrent symptoms after successful transformimal percutaneous endoscopic discectomy. The mean time to relapsing radiculopathy was 1.5 months (1-2 months) with 8 on the visual analogue scale scores. On the postoperative MRI, cystic lesion of T2WI high (similar to cerebrospinal fluid) and T1W low at discectomy site was found in both patients. Results One case was conducted with partial hemilaminectomy and discectomy. A dark red cystic mass containing old bloody fluid was found intra-operatively, and the histology of the cyst wall showed nucleus-like tissue, and inflammatory granulation tissue containing neovascularization and inflammatory cell infiltration in some area. The other case was conducted transformimal percutaneous endoscopic discectomy again, and dark red granulation tissue was found intra-operatively, and the histology of capsule wall showed fibrous connective tissue. Both cases achieved successful pain relief after the second surgeries. And MRI demonstrated the pseudocysts disappeared 3 months follow-up postoperatively. Conclusion Symptomatic post-discectomy pseudocyst is a rare complication after transformimal percutaneous endoscopic discectomy. It usually occurs in the early period postoperatively. MRI can confirm the diagnosis. Patients with failed conservative treatment can treat with surgery, and the prognosis is good. Key words: Diskectomy; Endoscopy; Postoperative complications

The diagnosis and treatment of cystic dilation of the ventriculus terminalis with 8 cases report

Objective To study the diagnosis and treatment of cystic dilation of ventriculus terminalis (CDVT).Methods The clinical manifestations and MRI characteristics of 8 cases of CDVT treated from Jan.2006 to May.2013 were analyzed.Results There were 6 female and 2 male patients.The mean age of patient was 47.1 years old.The main symptoms were leg pain and spine cord compression.These lesions were spindle shaped,smooth walled,and without internal septae.The cystic contents had the same signal as cerebrospinal fluid on T1 and T2 MRI images,and without contrast enhancement.Two patients with Type Ⅰ (nonspecific complaints) symptoms were treated conservatively.The surgical treatment consisted of dorsolumbar laminotomy,myelotomy,and cyst-subarachnoid shunt placement.In patients with Type Ⅱ (focal neurological deficits) and Ⅲ (sphincter disturbances) symptoms,surgical treatment sustained improvement.Conclusions CDVT is a rare congenital lesion.MRI is the first choice of diagnosis technique.Adequate decompression and cyst-subarachnoid shunt placement are the optimal treatment.Treatment for Type Ⅰ lesion seems to be best conducted conservatively,whereas Types Ⅱ and Ⅲ seem to be best handled surgically. Key words: Cystic dilation of the ventriculus terminalis; Cyst-subarachnoid shunt; Microsurgery

Microsurgical procedure combined with thoracoscopic resection for thoracic spinal canal dumbbell-shaped tumors

Background Spinal canal dumbbell-shaped tumor growing to spinal canal and paravertebral, may compress the spinal cord and invade the spinal canal, intervertebral foramen and spinal structures, and cause clinical symptoms. The dumbbell-shaped tumor in the thoracic vertebrae can penetrate thorax to cause pleural irritation symptoms, such as chest pain, short breath, cough and so on. As the microsurgical technique and video-assisted thoracoscopic surgery can remarkably reduce the harm, retrospective analysis was performed in order to explore the combined treatment of microsurgical proceduse and thoracoscopic resection for spinal canal dumbbell-shaped tumor and to summarize the surgical experience. Methods and Results There were 4 cases with thoracic spinal canal dumbbell-shaped tumors, among them 3 were typeⅡ and one was typeⅢ. In the surgery, 3 patients with typeⅡ underwent posterior mediastinal tumor resection under thoracoscope, and then underwent hemilaminectomy through posterior median approach. Under microscope, the tumors were entirely excised with excellent exporsure. The patient with type Ⅲ was firstly subjected to spinal canal tumor excision, and then entirely excisied intrathoracic tumor under thoracoscope. In 2 cases, the uncommon feelings became worse after surgery, but became better after half a year. In one case, the weakness of two legs, chest pain and cough were remarkably relieved, and in one case dry cough obliterated. During the follow-up period, there was no serious complication or death, and MRI revealed that the tumors were entirely excised without relapse. Conclusion The posterior median hemilaminectomy combined with video-assisted thoracoscopic surgery to treat spinal canal dumbbell-shaped tumors has following advantages: small trauma, few complication, good effectiveness and rapid recovery, which can be used as preferred treatment for spinal canal dumbbell-shaped tumor. doi：10.3969/j.issn.1672-6731.2013.12.004

Unilateral hemilaminectomy for the microsurgical removal of intraspinal tumors

Objective To evaluate the advantages and disadvantages of unilateral hemilaminectomy for the microsurgical removal of intraspinal tumors. Methods Clinical data of 19 patients with intraspinal tumors were analyzed from August 2008 to April 2013. All cases were treated microsurgically using unilateral hemilaminectomy procedures. Results Tumors were totally removed in all patients, including 12 cases of schwannoma, 1 case of neurofibroma, 5 cases of spinal meningioma and 1 case of hemangioblastoma. After operation signs and symptoms of every patient were significantly improved. Postoperative follow-up period was 6-60 months. No recurrence and spinal instability were found. The average area of intraoperative unilateral hemilaminectomy was (15 ± 2) mm × (32 ± 5) mm. Conclusion Unilateral hemilaminectomy for the removal of intraspinal tumors is a mini-invasive procedure, and is beneficial to the stability of spine, with the advantages of short hospitalization time, slight postoperative reaction and good long-term outcome. However, the procedure requires a skilled technology. doi: 10.3969/j.issn.1672⁃6731.2013.11.007 Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n11a7

Modified unilateral laminotomy for bilateral decompression of lumbar spinal stenosis

Objective To describe the technique and therapeutic effect of modified unilateral laminotomy for bilateral decompression (M-ULBD) for lumbar spinal stenosis (LSS).Methods A total of 56 patients with LSS were randomly divided into group A and B.The 27 patients in group A (15 males and 12 females,with an average age of 59.4 years) underwent M-ULBD.The other 29 patients in group B (18 males and 11 females,with an average age of 61.6 years) received conventional laminectomy.JOA score of low back pain,VAS,CPK three days after operation,pre-and post-operative cross-sectional areas of multifidus were used to evaluate the clinical results.Results A total of 45 patients (21 in group A and 24 in group B) completed 2 years of follow-up.The preoperative VAS of low back pain,leg pain,numbness,JOA score and cross-sectional areas of multifidus were 5.6±1.7,7.1±0.4,11.6±2.6,5.8±1.8 cm2 in group A and 6.2±1.2,7.9±1.3,10.9±1.0,6.1±2.0 cm2 in group B.There was no significant difference in preoperative data between both groups.The union of split spinous process was observed in all cases 6months later according to computed tomography.The postoperative CPK was lower in group A.The postoperative JOA and VAS scores in both groups were improved significantly compared with the corresponding preoperative ones.The VAS of leg pain,numbness,JOA score,and JOA recover rate in latest follow-up were 1.3±0.2,1.5±0.7,26.7±2.1,86.1％±3.1％ in group A,and 1.7±0.3,2.0±1.3,24.3±2.5,83.6％±6.4％ in group B,respectively.All these data have no difference between group A and B.The VAS of low back pain and atrophy rate of multifidus were 1.0±0.5,6.4％±1.2％ in group A,and 2.6±0.7,15.7％±3.0％ in group B respectively.All these data are lower in group A.Conclusion Our two years follow-up shows that this method is efficient for lumbar spinal stenosis treatment,however,it still need long term follow-up and to compare with other modified methods. Key words: Lumbar vertebrae; Spinal stenosis; Decompression, surgical; Laminectomy

Application of rehabilitation exercise program for surgical patients with prolapse of lumbar intervertebral disc

Objective To discuss the effect of rehabilitation exercise program on surgical patients with prolapse of lumbar intervertebral disc.Methods Rehabilitation exercise program was formulated.70 patients with prolapse of lumbar intervertebral disc who had enestration operation or hemilaminectomy discectomy were randomly divided into the observation group and the control group,each with 35 cases.The observation group had rehabilitation exercise program for intervention,while the control group only received materials including written rehabilitation exercise methods and postoperative announcements to guide self-exercise.Chinese Medical Association of Orthopaedics was used to evaluate the excellent rate of clinical effect,and SF-36 was used to compare patients' health related quality of life before and one year after the surgery.Results 61 out of 70 patients finished the follow-up for a year,in which 31 were the observation group and 30 were the control group.9 cases lost contact,with the rate of 12.8％.The excellent rate of curative effect was 93.5％ in the observation group and 73.3％ in the control group,and the difference was statistically significant (x2 =4.063,P ＜0.05).There was no statistically significant difference in SF-36 scores before surgery (P ＞ 0.05).But one year after the surgery,the score of physiological function,psychological function,body pain,overall health,vitality,social function,emotional function and mental health in SF-36 was respectively (55.4 ± 11.2),(49.6 ± 7.5),(78.1±10.5),(67.5±14.5),(72.3±12.2),(77.0±18.1),(68.6±23.2) and (78.9±10.3) in the observation group,all of which were higher than those in the control group,and the differences were statistically significant (t =2.643,4.321,3.012,2.102,2.412,2.210,2.120,2.321,respectively; P ＜ 0.05).Conclusions Rehabilitation exercise program for surgical patients with prolapse of lumbar intervertebral disc can help improve their clinical effect and postoperative quality of life obviously,which is worthy of clinic application. Key words: Lumbar disc herniation; Surgical treatment; Rehabilitation exercise; Quality of life

A model of acute compression spinal cord injury by a mini-invasive expandable balloon in goats

To establish a reproducible and manipulable model of acute spinal cord compression injury in large mammals so as to provide a technical and experimental platform for the repair and reconstruction of spinal cord injury (SCI). A total of 15 adult male goats, weighting 35 - 45 kg, were selected. After intravenous anesthesia, a model of acute spinal cord compression injury was established with the balloon of kyphoplasty through mini-open laminotomy. The animals were divided into 4 groups, i.e. 3 in group A and 4 each in groups B, C and D. Goats in group A received mini-open laminotomy without insertion of balloon. In group B, balloons were surgically positioned within the T10-T11 spinal canal but not inflated. The spinal cords of goats in group C were partially compressed by inflating the balloon to approximately 30% of anterior/posterior diameter of vertebral canal. In group D, the balloon was inflated to occupy approximately 90% of canal on a lateral view. X-ray and thin-section computed tomography (CT) scans were used to determine the balloon location. CT scans were also used to calculate the magnitude of balloon inflation and the degree of spinal cord compression within vertebral canal. Improved Tarlov motor function grade test and somatosensory evoked potentials (SSEP) were employed to evaluate the goat neurofunction 24 hours before and 7 days after surgery. Dye volumes of 0, 1.26 ± 0.18 and 2.82 ± 0.20 ml were injected into the balloon to produce spinal occupancies of 0%, 33% ± 2% and 89% ± 4% on X-ray and CT scan. There was a significant dose response for the different levels of injury, with reduced conduction of somatosensory evoked potentials and impaired mobility 7 days after injury. A model of acute spinal cord injury by a tunable compression with a mini-invasive balloon in goats is a useful experiment model of spinal cord injury. It may simulate the clinical situations of acute SCI.

Commentary: Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis–associated radiculopathy

Commentary on Parker SL, Fulchiero EC, Davis BJ, et al. Cost-effectiveness of multi-level hemilaminectomy for lumbar stenosis–associated radiculopathy. Spine J 2011;11:705–11 (in this issue) .

Surgical treatment for the intraspinal extramedullary neoplasms in the cervical vertebrae (a report of 26 cases)

Objective To investigate the different operative style for the intraspinal extramedullary neoplasms in the cervical vertebrae as well as evaluate the clinical effect of titanium net for spinal canal reconstruction and bone autograft after laminectomy. Methods Since March 2002 to September 2008, 26patents (14 men, 12 women) with the intraspinal extramedullary neoplasm in the cervical vertebrae. The average age was 38 years (range, 6-76 yr). According to Frankel classification, there were 26 cases for grade B before operation, 8 cases for grade C, 11 for grade D, and 4 for grade E. All patients underwent hemilaminectomy (as group HL) or total laminectomy combined with spinal canal reconstruction with titanium net (as group TL). Recovery of nerve function and bone fusion were recorded. Preoperative and postoperative cervical curvature index and ranges of neck motion were recorded and compared. Results Among the 3cases with incomplete paraplegia, neurological status ameliorated from Frankel grade B to C; 8 cases of Frankel grade C recovered to grade D; 11 cases of Frankel grade D improved to grade E in 10 cases and 1to grade D. Bone fusion was formed on the titanium net and spinal stability was well after operation. Loss of cervical curvature indices was 2.2±2.3 in group HL and 4.3±2.5 in group of TL, and the difference was of statistically significant (t=2.05,P＜0.05). At the same time, loss of ranges of neck motion was 1.3°±1.2°ingroup of HL and 9.2°±4.1°in group TL, significant difference was also seen (t=1.71 ,P＜ 0.05). Conclusion Hemi-laminectomy approach to intradural lesions lends itself well to eccentric tumors with smaller size. For the cases of total laminectomy, it is necessary and reliable to reconstitute integrity of spinal canal with titanium net and bone autograft. Key words: Cervical vertebrae; Spinal cord neoplasms; Spinal canal

Outpatient Laminotomy and Discectomy

Outpatient Laminotomy and Discectomy

Outpatient Laminotomy and Discectomy

Outpatient Laminotomy and Discectomy

Outpatient Laminotomy and Discectomy

Outpatient Laminotomy and Discectomy