J Korean Neurosurg Soc.  2015 Nov;58(5):494-498. 10.3340/jkns.2015.58.5.494.

Spinous Process-Splitting Hemilaminoplasty for Intradural and Extradural Lesions

• Lee YS
• Kim YB
• Park SW

• KMID: 2191420
• DOI: http://doi.org/10.3340/jkns.2015.58.5.494

Abstract

OBJECTIVE
To describe a novel spinous process-splitting hemilaminoplasty technique for the surgical treatment of intradural and posterior epidural lesions that promotes physiological restoration.
METHODS
The spinous process was split, the area of the facet lamina junction was drilled, and en bloc hemilaminectomy was then performed. After removing intradural and posterior epidural lesions, we fitted the previously en bloc-removed bone to the pre-surgery same shape, and held it in place with non-absorbable sutures. Surgery was performed on 16 laminas from a total of nine patients between 2011 and 2014. Bony union of the reconstructed lamina was assessed using computed tomography (CT) at 6 months after surgery.
RESULTS
Spinous process-slitting hemilaminoplasty was performed for intradural extramedullary tumors in eight patients and for ossification of the ligament flavum in one patient. Because we were able to visualize the margin of the ipsilateral and contralateral dura, we were able to secure space for removal of the lesion and closure of the dura. None of the cases showed spinal deformity or other complications. Bone fusion and maintenance of the spinal canal were found to be perfect on CT scans.
CONCLUSION
The spinous process-splitting hemilaminoplasty technique presented here was successful in creating sufficient space to remove intradural and posterior epidural lesions and to close the dura. Furthermore, we were able to maintain the physiological barrier and integrity after surgery because the posterior musculature and bone structures were restored.

Keyword

Spinous process-splitting hemilaminoplasty; Physiological integrity; Intradural and posterior extradural lesion

MeSH Terms

Congenital Abnormalities
Humans
Ligaments
Spinal Canal
Sutures
Tomography, X-Ray Computed

Figure

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  Fig. 1 A : Intradural spinal lesion (red). B : hemilaminectomy after splitting of the spinous process (using ossillating saw or T-saw) and laminofacet jounction (using match head burr). C : Contralateral spinolamina junction undercutting and exposure contralateral dural margin. D : Removal intraldural lesions and performed hemilaminoplasty.

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  Fig. 2 Case 1. A 57-year-old woman with an intradural extramedullary schwannoma at C3-4-5. Preoperative gadolinium-enhanced T1-weighted magnetic resonance imaging, where the sagittal and axial images reveal a left-sided intradural extramedullary lesion (A and B). Computed tomography scans obtained immediately after surgery (C) and 6 months after spinous process-splitting hemilaminoplasty (C3-4-5) (D), suggesting complete bone fusion.

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  Fig. 3 Case 5. A 55-year-old man with a schwannoma. A : Preoperative T2-weighted axial magnetic resonance image. B : Preoperative axial computed tomography image. The tumor was completely removed via spinous process-splitting hemilaminoplasty at L1. C : Computed tomography scans obtained immediately after the laminoplasty.

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  Fig. 4 Case 5. Intraoperative image. A : While performing spinous process-splitting laminectomy, the dura on both sides was visible. B : A width of approximately 1 cm was available for surgical entry.

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  Fig. 5 Case 7. A 62-year-old woman with cervical schwannoma. A : Preoperative T2-weighted axial magnetic resonance image. B : Preoperative axial magnetic resonance image. C : Computed tomography scans obtained immediately after the laminoplasty.

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