Thoracic Spinal Canal Research Articles

Technical Nuances of the Posterior Transpedicular Thoracic Diskectomy: 2-Dimensional Operative Video.

Thoracic disk herniations are relatively rare when compared with cervical and lumbar disk pathology accounting for less than 3% of spinal disk herniations.1 In addition to this, a larger proportion of thoracic disk herniations are calcified making them challenging to remove because of adherence to the dura and anatomy of the thoracic spinal canal.2,3 Owing to these unique features of thoracic disk herniations, typical posterior approaches are not always feasible to provide adequate decompression of the thecal sac.4 In this video, we present a 64-year-old male patient who presented with progressive paraplegia and a large ventral, eccentric, calcified thoracic disk herniation causing severe canal stenosis. Because of the size and location of the disk, a thoracic laminectomy with costotransversectomy and pediculectomies for resection of the disk was performed. Ventral decompression was achieved, and the patient made a full neurologic recovery. This video highlights the principles and technical nuances used during thoracic disk resection. The patient provided informed consent for surgery and video recording.

Transesophageal echocardiography for thoracic spinal cord imaging and confirmation of epidural catheter placement in pediatrics

IntroductionTransesophageal echocardiography (TEE) use continues to expand to include extracardiac applications. However, there is limited research investigating the use of TEE as a tool to confirm the position of the epidural catheter. This prospective observational study aimed to evaluate whether TEE could be used to visualize the anatomy of the thoracic spinal canal in pediatrics. A subsequent prospective case series was conducted to evaluate whether TEE could be used to assist in the placement of epidural catheters in pediatric surgical patients. MethodsSeventy-five patients (50 pediatric and 25 adult subjects) were enrolled. The operators attempted to identify four structures (spinal cord, cerebrospinal fluid, dura mater, epidural space) within the thoracic spinal canal with TEE. After demonstrating the feasibility of this technique for observing the spinal anatomy, 20 pediatric surgical patients were enrolled in a case series. These patients had epidural catheter placement, and the final catheter position was confirmed with TEE. ResultsThe total number of thoracic spinal segment visualized in pediatric patients was 542 out of 550 (99%) segments, and 191 out of 275 (70%) segments in adult subjects (difference, 29% [95% confidence interval, 23–34]; p < 0.001). Additionally, a case series of 20 pediatric surgical patients demonstrated successful caudal or epidural catheter placement at target spinal level in 17 cases. ConclusionsThis observational study demonstrated the successful visualization of the thoracic spinal cord at virtually every level in pediatric patients. A subsequent case series demonstrated that TEE could be used to successfully confirm the position of the epidural catheter in the targeted thoracic spinal segment for pediatric surgical patients.

Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case.

Nonmissile penetrating spinal cord injury (NMPSCI) with a retained foreign body (RFB) is rare and usually results in permanent neurological deficits. In extremely rare cases, patients can present without significant neurological deficits despite an RFB that traverses the spinal canal. Given the rarity of these cases, a consensus has not yet been reached on optimal management. In a patient with an RFB and a neurologically normal clinical examination, the risk of open surgical exploration may outweigh the benefit and direct withdrawal may be a better option. A 10-year-old female suffered an NMPSCI to the thoracic spine with an RFB that bisected the spinal canal but remained neurologically intact. Direct withdrawal of the RFB was chosen instead of open surgical exploration, leading to an excellent clinical outcome. The literature was reviewed to find other examples of thoracic NMPSCI with RFB and neurologically normal examinations. Management strategies were compared. For NMPSCI with RFB and without significant neurological deficits, direct withdrawal is a viable and possibly the best treatment option. The use of fast-acting anesthesia without intubation minimizes patient manipulation, speeds up recovery, and allows early assessment of neurological status after removal.

The effect of pedicle screw instrumentation at a young age on upper thoracic vertebra and canal development

BACKGROUND CONTEXTPedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the posterior arch to the vertebral body. However, there are several concerns about the impact of pedicle screw instrumentation insertion on vertebral development in young children, including early closure of the neurocentral cartilage (NCC). The effect of pedicle screw insertion in an early age on further growth of the upper thoracic spine is still unclear. PURPOSEThis study aimed to evaluate the impact of pedicle screw insertion on further growth of the upper thoracic vertebra and spinal canal. STUDY DESIGNA retrospective case study. PATIENT SAMPLETwenty-eight patients. OUTCOME MEASUREMENTSX-ray and CT parameters including length, height and area of the vertebrae and spinal canal were manually measured. METHODSTwenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital were recruited, and records were retrospectively reviewed. Vertebral body and spinal canal parameters were measured at instrumented and adjacent noninstrumented levels and compared using statistical methods. RESULTSNinety-seven segments met the inclusion criteria (average age at instrumentation 44.57 months, range from 23–60 months). Thirty-nine segments had no screws, and 58 had at least one screw. There was no significant difference between the preoperative and final follow-up values of the measurement of vertebral body parameters. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters. CONCLUSIONPedicle screw instrumentation in the upper thoracic spine does not cause a negative effect on the development of the vertebral body and spinal canal in children younger than 5 years old.

Clinical Results and Review of Techniques of Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression (TE-ULBD) Using the Outside-In Technique for Thoracic Ossified Ligamentum Flavum

Objective: Uniportal full endoscopic thoracic endoscopic surgery can be performed through transforaminal and interlaminar approaches. The interlaminar approach is commonly described as thoracic endoscopic unilateral laminotomy for bilateral decompression (TE-ULBD), which is typically indicated for pathologies such as ossified ligamentum flavum and other posteriorly based compressive pathologies. TE-ULBD decompresses the central and lateral recesses of the thoracic spinal canal. Both the outside-in (over the top of ligamentum flavum) and inside-out (under the ligamentum flavum) approaches can decompress the thoracic spinal canal through the uniportal interlaminar endoscopic route.Methods: A retrospective clinical cohort evaluation of patients who underwent TE-ULBD was performed from January 2018 to December 2021 Results: A cohort of 50 cases of TE-ULBD with a mean age of 65 years old were evaluated. The complication rate was 5.4% and the reoperation rate was 2%. Statistically significant mean VAS improvements were found at 1 week, 6 months, and the final follow-up, with changes of 3.95 ± 1.49, 4.95 ± 1.7, and 5.2 ± 1.8 points, respectively. Likewise, the mean Oswestry Disability Index improvements at 1 week, 3 months, and the final follow-up were 33.8 ± 9.05, 40.12 ± 10.38, and 41.92 ± 11.26, respectively (p &lt; 0.001). Significant improvements were found in the cross-sectional area of the spinal canal in the upper endplate, mid-disc, and lower endplate (57.62 ± 50.6, 89.86 ± 55.93, and 64.93 ± 60.91 mm&lt;sup&gt;2&lt;/sup&gt;, respectively; p &lt; 0.001). Conclusion: TE-ULBD using the outside-in technique could achieve good clinical outcomes and a low rate of complications in our cohort of patients.

Emergency surgery for a patient with a thoracic spinal epidural abscess: a case report and literature review

A man in his early 40s visited the Emergency Department because of no motor function in his lower limbs for 10 hours. Magnetic resonance imaging of his thoracic spine showed that the thoracic spinal canal (T2-T6) was occupied, and the thoracic spinal cord was compressed. In view of the severe symptoms, we quickly completed preoperative preparations and performed a thoracic laminectomy within 24 hours of paralysis of both lower limbs. Postoperatively, the patient underwent rehabilitation exercise. Four weeks later, the patient's lower limbs had full 5/5 strength. We reviewed the related literature to summarize the clinical guidelines with spinal surgeons. Timely diagnosis of thoracic spinal epidural abscess, early surgical treatment, and anti-infection management and rehabilitation exercise are essential for the full recovery of lower limb muscle strength.

Clinical efficacy of resection of extramedullary subdural tumor in thoracic spinal canal via muscle-pedicle open-door laminoplasty approach

In order to evaluate the efficacy of resecting extramedullary subdural tumors, located in the thoracic spinal canal, via the muscle-pedicle open-door laminoplasty approach, clinical data of fifteen patients with thoracic spinal tumors admitted to the Department of Spinal Surgery in the Affiliated Hospital of Qingdao University from December 2018 to June 2021 were analyzed retrospectively. All patients received surgical treatment to remove the tumors via the muscle-pedicle open-door laminoplasty approach. The clinical data of the patient was recorded. The Japanese Orthopedic Association (JOA) score, the thoracic kyphosis angle in the standing position before and after the operation, and the visual analog score (VAS) of thoracic back incision pain before and after the operation were compared. CT scan was performed three months after the surgery and at the last follow-up to measure the healing of the lamina. In addition, MRI was used to detect the healing of the posterior ligament at the last follow-up. The tumors of all fifteen patients were completely removed, the operating time was (91±15) minutes, blood loss was (117±56) ml. Cerebral spinal fluid leakage occurred in three patients, but the incisions healed smoothly following compression and no complication was observed. All patients were followed-ups for more than 6 months. The VAS score of thoracic back incision pain was (3±1.3) points at three days post operation and it dropped to (1.3±0.9) points three months post-operation. The JOA score improved significantly after the operation, it was (11.9±2.4) points before operation, and it was (14.0±1.6) points three months post operation and increased to (16.1±0.7) points at the last follow-up (both P<0.001). The Cobb angle was 10.1°±5.3° before the operation and it was 10.4°±6.2° at the last follow-up (P=0.420). Three months after operation, partial callus formation or even complete healing on the muscle pedicle side was observed on the CT scans of all patients. At the last follow-up, CT scans showed complete healing on the muscle pedicle side. There were different degrees of sclerosis and healing on the open-door side. There was no necrosis, displacement, or secondary spinal canal stenosis in any vertebral lamina. It indicated that the muscle-pedicle open-door laminoplasty approach is an effective way to resection extramedullary subdural tumors located in the thoracic spinal canal.

The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging in children aged 0 to 13 years old

The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging in children aged 0 to 13 years old

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients. Un niño de 10 años se presentó al departamento de neurocirugía después de una herida de bala en la columna torácica superior. La bala entró por el músculo deltoides derecho y se alojó dentro del canal espinal a nivel T1. El paciente llegó consciente y obedeciendo órdenes; sin embargo, experimentó una pérdida de sensibilidad por debajo del nivel T3, pérdida de reflejos por debajo del nivel T1 lesionado, pérdida del tono del esfínter anal y paraplejía en las extremidades inferiores (American Spinal Injury Association grado-A). Los estudios de imagen revelaron una bala metálica intracanalicular a nivel T1. El paciente fue intervenido de urgencia mediante un sistema retractor tubular y el microscopio. Posteriormente, la bala se recuperó con éxito. En el postoperatorio, el paciente se recuperó significativamente y, al final del sexto mes, podía caminar de forma independiente a pesar de cierta inestabilidad en la marcha. Un enfoque mínimamente invasivo para la extracción de balas intracanaliculares en la región torácica es una técnica segura y eficaz en pacientes pediátricos.

Meningeal carcinomatosis secondary to neurenteric cysts with malignant transformation: a case report

BackgroundMeningeal carcinomatosis is mainly associated with breast cancer, lung cancer, and melanoma. However, meningeal carcinomatosis secondary to a neurenteric cyst with malignant features is extremely rare.Case presentationWe report the case of a 35-year-old woman who was admitted to the hospital with a 10-month history of headache, 6-month history of diplopia, 4-month history of hearing loss, and 1-month history of back pain, suggesting a diagnosis of chronic meningitis. Notably, enhanced brain and spinal cord magnetic resonance imaging (MRI) revealed extensive lesions with enhancement signals in the pia mater of the pons and cervical, thoracic, and lumbar spinal cord. The cerebral spinal fluid profile showed that pressure was significantly elevated, with a slight increase in leukocytes that mostly comprised mononuclear cells and decreased glucose concentration. Cytology evaluation showed a small cluster of atypical nuclei, which were suspected to be tumor cells arising from the epithelium. However, no primary tumor was found through comprehensive body and skin screening. After a histopathological biopsy of subarachnoid meninx of the thoracic spinal canal, the cause of meningeal carcinomatosis of this patient was determined as neurenteric cysts with malignant features, which is extremely rare.ConclusionThis is the first case to ever report neurenteric cysts as a cause of leptomeningeal carcinomatosis and the first ever report of neurenteric cysts presenting as leptomeningeal carcinomatosis without typical cyst visible on brain MRI. This extremely rare case provided a novel view on the pathogenesis of meningeal carcinomatosis and clinical presentation of neurenteric cysts, highlighting the value of meningeal biopsy in chronic meningitis of unknown causes.

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

IL-6 is involved in thoracic ossification of the ligamentum flavum.

Thoracic ossification of the ligamentum flavum (TOLF) is a heterotopic ossification of spinal ligaments. TOLF is the major cause of thoracic spinal canal stenosis and myelopathy, and its underlying mechanisms are not clear. Bone formation is a complex developmental process involving the differentiation of mesenchymal stem cells to osteoblasts, and regulated by BMP2, RUNX2, Osterix (OSX), etc. In this study, we continue to further characterize properties of TOLF. Our immunohistochemistry experiments showed that expressions of osteoblastic factors such as BMP2 and RUNX2 increased in TOLF. According to flow cytometry analysis the proportion of S phase of cell cycle in primary TOLF cells was 9% higher than the control. Alizarin red staining and ALP staining observations were consistent with immunohistochemistry results. It was also observed that inflammatory cytokine IL-6 level dramatically increased in the culture supernatant of primary TOLF cells. We propose the hypothesis that IL-6 is involved in TOLF. To testify the hypothesis, we examined the effect of IL-6. Our results showed that IL-6 was able to activate expressions of osteoblastic factors such as BMP2, RUNX2, OSX, OCN and ALP, and that expressions of cell proliferation factors cyclin D1 and cyclin C increased in the presence of IL-6. Moreover, IL-6-induced BMP2 expression was inhibited by p38 inhibitor SB203580, indicating that IL-6 regulated the osteogenic BMP2 activation through p38 MAPK pathway. These data suggest that IL-6 is involved in TOLF.

Phase I 270° single-incision percutaneous spinal endoscopy for decompression treatment of thoracic spinal stenosis

This study aimed to explore the feasibility of Phase I percutaneous spinal endoscopy with a 270° single incision in the ventral and dorsal dura mater for decompression treatment of thoracic spinal stenosis (TSS). Phase I percutaneous spinal endoscopy with a two-path (posterior and posterolateral approaches) single incision with a 270° decompression was performed in four cases of TSS with compression in the ventral and dorsal dura mater. The affected intervertebral space was located during the surgery, and the ossified ligamentum flavum in the ventral and dorsal dura mater was removed via laminectomy, which formed a decompression space in the thoracic cord. Next, posterolateral transforaminal expansion and plasty were performed to remove the ventral intervertebral disk. The visual analogue scale (VAS) score, thoracic spinal cord function score of the Japanese Orthopaedic Association (JOA) (11-point method), and Oswestry Disability Index (ODI) scores were used to evaluate the clinical efficacy. No dura mater or thoracic nerve injury occurred during the surgery. The symptoms of weakness in the lower extremities improved after the surgery. The postoperative magnetic resonance imaging and computed tomography examinations showed compression removal and dura mater bulging. The postoperative VAS, JOA, and ODI scores improved compared with the preoperative scores. Two surgical trajectories, posterior and posterolateral approaches, were established by a single incision using thoracic spinal canal decompression with Phase I 270° single-incision percutaneous spinal endoscopy. The posterior approach was performed mainly by translaminar unilateral fenestration and bilateral decompression in the ventral and dorsal dura mater, whereas the posterolateral approach was performed by decompression in the ventral dura mater to the midline of the vertebrae. This surgical method could be applied as a safe and feasible minimally invasive treatment for TSS with compression on both the ventral and dorsal dura mater.

The Management of Idiopathic and Refractory Syringomyelia.

Idiopathic syringomyelia (IS) and refractory syringomyelia (RS) are types of syringomyelia that often pose a management challenge and are associated with long-term clinical sequela. They are usually an epiphenomenon reflecting an underlying pathology where the treatment of the primary cause should be the aim for any surgical intervention. In the case of IS, the initial step is agreeing on the definition of the terms idiopathic and syringomyelia. After a rigorous exhaustive clinic-radiological workup, only IS patients with progressive neurology are treated, usually unblocking subarachnoid cerebrospinal fluid (CSF) pathway obstruction somewhere in the thoracic spinal canal and reserving shunting techniques to nonresponsive cases. Similar to IS, also RS is multifactorial, and its management varies based on the initial pathology, strongly supported by radiological and clinical features. We aim to address this topic focusing on the etiopathology, investigation paradigm, and surgical pathway, formulating algorithms of management with available evidence in literature. Surgical techniques are discussed in detail.

Plexiform Cellular Schwannoma in Infancy and Childhood: A Clinicopathological Study of Seven Cases of an Underrecognized Nerve Sheath Tumor with a Tendency Toward Local Recurrence

Plexiform cellular schwannoma (PCS) is very rare, and it is not completely understood. We present our experience with 7 additional cases of PCS in infancy and childhood to further characterize its distinctive clinicopathological features. There were 5 females and 2 males with a mean age of 28 months (ranging, 2 months to 8 years). The involved sites included the left forearm (n = 2), sacrococcygeal region (n = 2), retroperitoneum (n = 1), thoracic spinal canal and thoracic cavity (n = 1), and neck (n = 1). Tumor sizes ranged from 3 to 13 cm in maximum diameter (mean, 7.1 cm). Histologically, all tumors consisted of abundant spindle cells arranged in a multinodular or plexiform growth pattern, possessing elongated, hyperchromatic nuclei and pale eosinophilic cytoplasm with indistinct cell margins. Mitotic figures were easily identified, with a mean count of 4 per 10 consecutive high power fields (HPF). Immunohistochemically, all tumors were strongly and diffusely positive for S100 protein, SOX10 and H3K27me3. The Ki-67 index ranged from 5% to 30% (mean, 15%). Follow-up (available in 6 cases) revealed that 5 patients experienced local recurrence and were treated by re-excision. There was no evidence of recurrence and metastasis in 3 patients, and the other 2 were alive with the disease. In conclusion, PCS is an uncommon nerve sheath tumor predominantly occurring in infants and children, featuring a plexiform or multinodular growth pattern and exhibiting a tendency toward local recurrence. PCS is easily mistaken as malignant peripheral nerve sheath tumor (MPNST) due to its locally aggressive behaviors and worrisome features, including hypercellularity, hyperchromatism and high proliferative activity. Increased awareness of its potential occurrence and greater familiarity with its characteristic features are helpful for both clinicians and pathologists to avoid misdiagnosis and unnecessary overtreatment.

Thoracic ganglioneuroma with extension into the epidural space

A patient in their 30s presented with chronic right upper quadrant abdominal pain, nausea, bloating, and constipation. Her clinical exam was unremarkable, and computed tomography (CT) of the chest and abdomen which showed a large right-sided thoracic mass with extension into the thoracic spinal canal. A needle biopsy revealed a diagnosis of ganglioneuroma, the patient then underwent a combined approach for excision the tumor. Ganglioneuroma is a neuroblastic tumor of a neural crest origin, it originates from paravertebral sympathetic chain ganglia of the posterior mediastinum or retroperitoneum. They usually extend through neuroforamina to involve the epidural space and surgical excision can be curative.

Atraumatic thoracic spinal fracture mimicking herpes zoster neuralgia: a case report

BackgroundIntercostal neuralgia is most common in patients with herpes zoster, but it might be the initial symptom of serious diseases, such as atraumatic spinal fracture, which may lead to serious consequences if not diagnosed and treated early. Severe intercostal neuralgia is rarely reported as the first symptom of ankylosing spondylitis with atraumatic vertebral fractures.Case presentationA 70-year-old Chinese Han man previously diagnosed with ankylosing spondylitis presented to the hospital with intense intercostal pain without trauma. The patient was initially suspected of having herpes zoster neuralgia; however, he subsequently experienced numbness and weakness of both lower limbs as well as constipation. Thoracic vertebral fracture and compression of the spinal cord were detected with magnetic resonance imaging, and he underwent emergency posterior thoracic spinal canal decompression, and intercostal neuralgia was relieved after surgery. Spinal tuberculosis and tumors were later excluded by pathological examination and follow-up results. A 6-month postoperative follow-up showed that the weakness and numbness of the left lower limb had significantly improved, and his urinary function had recovered.ConclusionsPatients with ankylosing spondylitis could develop atraumatic spinal fractures. Severe intercostal neuralgia is an early indicator of spinal fractures, and spinal magnetic resonance imaging is crucial for the diagnosis.

Pictorial review: imaging of the spinal manifestations of achondroplasia.

Achondroplasia is the commonest hereditary skeletal dysplasia exhibiting dwarfism with characteristic rhizomelic (proximal) shortening of the limbs. It is predominantly linked with an autosomal dominant inheritance, but sporadic mutations can occur which are associated with advanced maternal age. Approximately 1 in every 25 000-30 000 live births are affected, and the overall life expectancy is marginally reduced by ~10 years. Mutations in the fibroblast growth factor receptor causes a decrease in endochondral ossification, which results in stunted growth of cartilaginous bones. A resultant narrowed foramen magnum and a short clivus are seen which predisposes to craniocervical spinal canal stenosis. Apnoeic events arising from the compression of the vertebral arteries at the level of the craniocervical junction lead to fatality in the young, with a death rate as high as 7.5%. Decrease in the caudal inter-pedicular distance is characteristic and a contributory factor for cervical, thoracic and lumbar spinal canal stenosis, most pronounced in the lumbar spine with patients often requiring surgical intervention to ease symptoms. Thoracolumbar kyphoscoliosis and sacral manifestations such as small sacro-sciatic notches and a horizontal pelvis are seen. The aim of this pictorial review is to demonstrate the imaging findings of the spinal and pelvic manifestations of achondroplasia.

Diagnosis Experience of Patients with Cervical, Thoracic and Lumbar Multi-Segment Spinal Stenosis: A Case Report and Literature Review

Background: The incidence of cervical, thoracic and lumbar spinal canal stenosis is low. It is difficult to identify the main focus and responsible segment, and it is also difficult to select the sequence of staging surgery. We report a patient with triple stenosis. Case Presentation: In this paper, we introduced a 61-year-old female patient with cervical, thoracic and lumbar spinal canal stenosis who had previously undergone “lumbar discectomy” in the outer hospital. The postoperative effect was not good and the symptoms were poor. The diagnosis was “cervical spinal stenosis and lumbar postoperative surgery”. The staged spinal canal decompression operation and Duhuo Jisheng Decoction (DHJSD) treatment were conducted in our hospital. After three months of follow-up, the functional and imaging results were satisfactory. Conclusions: The main focus and responsible spinal segment should be determined by the comprehensive analysis of medical history, signs, and images. Surgery combined with Chinese herbal medicine DHJSD therapy may be an effective treatment for this kind of disease.

A refined method of en bloc open-door laminoplasty for resection of intradural spinal tumors in the thoracic and lumbar spine

BackgroundThe open-door laminoplasty has been used to treat cervical spondylotic myelopathy. This technique has been applied to the surgical treatment of thoracic and lumbar spinal canal tumors instead of simple laminectomy or hemilaminectomy. However, previously reported laminoplasty methods did not keep posterior supporting elements intact such as the laminae and the spinous processes with supraspinous and interspinous ligaments, and almost all of them needed instruments for the fixation of reconstructed laminae. The purpose of this paper is to introduce our open-door laminoplasty method, which keep all posterior supporting elements intact and reconstruct the laminae without instrument. MethodsEight patients (mean age 61 years) underwent en bloc open-door laminoplasty in the thoracic and lumbar spine for resection of intradural spinal tumors. Two grooves are made bilaterally on the laminae just medial side of the facet joints. One-half of each spinous process of the adjacent vertebrae above and below the laminoplasty is cracked diagonally to create a green stick fracture and bent to the hinged side for sufficient elevation of the laminar flap. After tumor resection, the laminar flap is restored to its original site, resulting in the complete preservation of the posterior supporting elements. ResultsOperative exposure was good and permitted complete resection. No complications such as postoperative spinal canal stenosis or kyphosis were observed. Computed tomography(CT) indicated that bony fusion occurred in all cases. ConclusionThe supraspinous and interspinous ligaments above and below laminoplasty were kept intact during surgery in our method. Therefore, the continuity of posterior supporting elements (laminae and spinous processes connected by supraspinous and interspinous ligaments) were completely preserved.