Yonsei Med J.  2011 Jan;52(1):121-129. 10.3349/ymj.2011.52.1.121.

Hemilaminectomy for Removal of Extramedullary or Extradural Spinal Cord Tumors: Medium to Long-Term Clinical Outcomes

• Naganawa T
• Miyamoto K
• Hosoe H
• Suzuki N
• Shimizu K

• KMID: 1106446
• DOI: http://doi.org/10.3349/ymj.2011.52.1.121

Abstract

PURPOSE
Laminectomy is generally the treatment of choice for removal of spinal tumors. However, it has been shown that laminectomy may cause instability due to damage of posterior elements of the spinal column, which may induce subsequent kyphosis in the future. Therefore, to reduce the risk of deformity and spinal instability after laminectomy, hemilaminectomy has been used. However, the medium to long-term effects of hemilaminectomy on spinal sagittal alignment is not well understood. The present study was performed to evaluate the clinical outcomes, including spinal sagittal alignment of patients, associated with spinal cord tumors treated by surgical excision using hemilaminectomy.
MATERIALS AND METHODS
Twenty hemilaminectomy operations at our institute for extramedullary or extradural spinal cord tumors in 19 patients were evaluated retrospectively with an average follow-up of 85 months (range, 40-131 months). Neurological condition was evaluated using the improvement ratio of the Japanese Orthopaedic Association Score (JOA score) for cervical, thoracic myelopathy, or back pain, and sagittal alignment by sagittal Cobb angle of the hemilaminectomied area.
RESULTS
The mean improvement ratio of neurological results was 56.7% in the cervical spine (p < 0.01, n = 10), 26.3% in the thoracic spine (not significant, n = 5), and 48.6% in the lumbar spine (NS, n = 5). The sagittal Cobb angle was 4.3 +/- 18.0degrees in the preoperative period and 5.4 +/- 17.6degrees at the latest follow-up, indicating no significant deterioration.
CONCLUSION
Hemilaminectomy is useful for extramedullary or extradural spinal cord tumors in providing fair neurological status and restoration of spinal sagittal alignment in medium to long-term follow-up.

Keyword

Hemilaminectomy; surgical treatment; spinal cord tumors; middle to long term clinical outcome; sagittal alignment

MeSH Terms

Adolescent
Adult
Aged
Female
Humans
Laminectomy/*methods
Male
Middle Aged
Retrospective Studies
Spinal Cord Neoplasms/*surgery
Treatment Outcome
Young Adult

Figure

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  Fig. 1 (A) Preoperative MRI of Case 9 showing extradural neurinoma of the upper cervical spine. (B) Postoperative MRI showing tumor resection by hemilaminectomy. Upper panel, Axial image; Lower panel, Sagittal image.

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  Fig. 2 The average improvement ratio of postoperative neurological status was 63.3% in tumors of the cervical region (p < 0.01), 13.3% in tumors of the thoracic region, and 61.8% in tumors of the lumbar region. IR, improvement ratio; JOA score, Japanese Orthopaedic Association Score.

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