Clinical Analysis Of Autologous Spinous Process-lamina Complex Replanted And Fixed By Titanium Sheet And Pins After Excision Of Intraspinal Tumor

Objective:To explore the clinical efficacy of spinous process lamina complex after excision of intraspinal tumor which involvement of the spinal segment is no more than 2.Methods:Retrospective analysis of clinical data of 70 patients undergoing spinal laparectomy with posterior median approach laminectomy from January 2015 to September 2017.They are divided into spinous process-laminate complex return group and non-spoinous process-laminate complex retun group,spinous process-laminar return group of 30 cases,12 males,18 females,aged 20-56 years old,average age40± 9.Duration from 1 month to 4.6 years ? In the non-spinous process-laminar composite recovery group,there were 40 cases,17 males and 23 females,aged22-54 years,mean age 43±10.Duration of 2 months to 3.5 years.The two groups of patients showed different degrees of nerve root pain,abnormal sensation,and other symptoms of spinal cord compression.The MRI scan and enhancement of the spinal cord were performed before the operation,and the location and size of the tumor were clearly defined with MRI.Pre-operative positioning with MRI,clarifying the tumor location,size,and relationship of the surrounding tissueAll patients had no clinical manifestations of spine instability before surgery.Patients in both groups were treated with prone position and general anesthesia.Spine-lamella complexes were completely resected and preserved during surgery in the spinous process-lamina complex group.After completion of tumor resection,the spinous process-lamella complex with micro titanium plate is returned to the spine in situ to reconstruct the stable structure of the spinal canal.In the non-returning group,the spinous process,lamina and related ligaments were excised with rongeurs and laminar clamps during surgery,and were not preserved.The reconstruction of the spine was not performed after complete tumor resection.The average length of hospital stay,postoperative cerebrospinal fluid leakage,short-term and long-term spinal cord recovery and spinal stability were compared by McCormick spinal cord function grading standard,review of spinal MRI and physical examination.Results:The average operating time for the spinous process-lamina complex group was 217±119 and 210±57 minutesin laminectomy group.The average length of stay after surgery in the spinous process-lamina complex group is 14±6 days a nd 19±7 days in Non-reconstruction group.The most common pathological types of spinous process-lamina complexes were 11 cases of schwannomas,followed by 7 cases of meningioma,2 cases of teratomas,3 cases of dermoid cysts,1case of ependymoma.3 cases of neurofibroma,2 cases of cavernous hemangi oma,1 case of lipoma.In the non-reconstruction group,there were 16 schwann omas,9 meningomas,1 ependymoma,2 dermoid cysts,2 arachnoid cysts,2 ca vernous hemangiomas,3 teratomas,and nerve fibers.1 case of tumor,1 case of hemangioblastoma,3 cases of epidermoid cyst.The number of cerebrospinal fluid leaks in the postoperative spinal reconstruction group and non-reconstructi on group were 2 and 11 cases.Mc Cormic classification was used to determine the long-term neurological function in the last follow-up.The results were 27 cases,2 cases and 1 cases of grade I,II and III respectively in the reconstruct ive group.20 cases,15 cases and 5 cases in the non reconstruction group,grad e I,II and III respectively.White and Panjabi scales were used to evaluate post operative spinal instability in both groups.There were 2 cases of spine instability,1 case of scoliosis,and 1 case of kyphosis in the spinous process-lamina group.In the non-returning group,spine instability occurred in 11 cases,of which 4 cases had severe clinical symptoms,with back pain and limited mobility and severe kyphosis in 1 patients who required surgical correction.ConclusionFor spinal tumor patients with no more than 2 segments,the stability of the spine should be reestablished at the same time.Spinal-lamina complex lamina operation as a method to maintain spinal stability after intraspinal tumor resection can effectively reduce postoperative complications,shorten the average length of hospital stay,and rebuild the posterior column structure of the spine.Integrity,restoring the original spine anatomy.This surgicalcan effectively maintain the stability of the spine,is a simple,effective and safe surgical method.