Application Of Vertebral Canal Reconstruction In The Excision Of Intraspinal Tumor

Objective: To investigate the effect of reconstruction of posterior column of spinal canal by replacing the spinous process and vertebral plate complex in situin intraspinal tumor surgery.Methods: Records of 105 consecutive patients undergoing intraspinal tumor resection from January 2014 to March 2016 in our department were reviewed retrospectively,of which 40 cases of laminoplasty group,16 males and 24 females,aged 12-80 years,the average age 49 ± 17 years old;65 cases of laminectomy,31 males and 34 females,aged 14-79 years,mean age 47 ± 16 years old.Patients underwent preoperative and postoperative magnetic resonance imaging(MRI)in all cases.All patients before surgery were different degrees of spinal cord or nerve root compression symptoms,no patients with preoperative deformity.We used the Mc Cormick scoring system to grade neurological status pre-and pro-operatively.Post-operative MRI and three-dimensional CT were performed periodically to assess spinal stability and were treated with Cobb angle> 10o as spinal instability.The incidence of subsequent spinal stabilization,postoperative complication and neurological outcome were compared between the laminoplasty and laminectomy cohorts.Results: Mean operation time was 96 ± 35 min in the laminoplasty group and 165 ± 34 min in the laminectomy;Gross total resection was achieved in 35 patients,subtotal resection was achieved in 5 patients in the laminoplasty,whereas 53 patients was total resected and 12 patients was subtotal resected in the laminectomy group;The distribution of cervical,thoracic and lumbosacral was not significantly different between the laminoplasty and laminectomy groups;In addition,the proportion of extradural,intradural-extramedullary and intramedullary tumours was not significantly different between the laminoplasty and laminectomy groups also;There were 18 cases of schwannomas,8 cases of meningiomas,6 cases of dermoid cysts,4 cases of ependymoma,2 cases of lipoma,2 cases of cavernous hemangioma in the laminoplasty group;And 32 cases of schwannoma,8 cases of meningioma,6 cases of ependymoma,3 cases of dermoid cyst,5 cases of lipoma,7 cases of cavernous hemangioma,3 cases of teratoma and 1 case of metastatic tumor in the laminectomy group.Laminoplasty was associated with a decreased mean length of hospitalization(11±3 days VS 15±4 days;P=0.04),shorter time of bed rest(8±4days VS 15±4 days;P=0.03)and decreased incisional cerebrospinal fluid leak(2.5% VS 15.4%;P=0.04).Comparing the ratio of?,?and ? graded patients in the laminoplasty group with the laminectomy group both pre-operatively(24,12,4 vs 31,17,17)and post-operatively(32,7,1 vs 37,12,16);Additionally,3(7.5%)VS 15(23.1%)patients developed progressive unstabilization18 months after surgery in laminoplasty and laminectomy group respectively(P=0.04).Conclusion Laminoplasty is safe and effective for patients underwent intraspinal tumor resection.It brings a decreased incidence of progressive spinal unstabilization and CSF leakage postoperation and improves neurological function recovery.