gms | German Medical Science

Surgery via postero- or posterolateral approaches is the therapy of choice for most intraspinal tumors. However, postoperative spinal instability due to laminectomy remains an important issue: After multilevel approaches spinal deformity and/or instability of >15% of patients have been reported. Therefore, in case of multilevel approaches, we performed a laminoplasty with refixation of the incised lamina(e) to avoid kyphosis and subluxation. Aim of the study was the prospective evaluation of alignement and stability after laminoplasty.

Clinical courses and postoperative imaging of 27 patients with intraspinal tumors were analyzed. Surgery was performed under microsurgical conditions with use of neurophysiological monitoring in all patients. Refixation was performed by non-resorbable sutures. All patients were evaluated pre- and postoperatively after two weeks and 6 months for clinical and radiological signs (MRI; conventional and functional X-Ray) of bone healing and spinal instability.

Mean age of patients was 41.1±18.7 years. 17 patients suffered from intramedullary tumors (12 x ependymoma, 5 x astrocytoma), 10 patients from benign extramedullary lesions (neurinoma/meningioma /lipoma). The mean number of excised and reimplanted laminae of the cervical spine was 3±1.1, of the thoracic spine 4.3±1.3, and of the lumbar spine 3±1.4. No patient suffered from myelon or nerve root lesions due to in-toto removal or refixation of the laminae. In one patient fixation of laminae C5-7 had to be renewed due to unilateral graft dislodgement, in one patient laminae C2-7 had to be removed due to infection. Less than 10% of all patients reported about postoperative local pain due to movement. There were no radiological signs of instability in any patient or secondary stabilizing procedure necessary.

Refixation of the laminae over multiple levels in surgery of intraspinal tumors of adult patients evolved to be a safe and – with growing experience – fast procedure for exposure and closure of the spinal canal. Laminoplasty seems to be a valuable method to avoid spinal instability and malalignement in surgery of extended intraspinal lesions.