Jiang Lijun, Luo Jie, Gong Haiyi, Zhang Fei, Zhang Linxiang, Cheng Linfei, Gao Xin, Zhang Dan, Liu Tielong, Xiao Jianru
School of Medicine, Ningbo University, Ningbo 315211, China.
Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China.
J Clin Med. 2023 Jan 2;12(1):355. doi: 10.3390/jcm12010355.
(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.
（1）背景：原发性椎管内肿瘤占所有中枢神经系统（CNS）肿瘤的2% - 15%。大多数椎管内肿瘤是良性的，其中约40%发生于硬脊膜内，对此早期手术是首选治疗方法。椎板切除术加椎弓根螺钉固定是传统的手术治疗方式。然而，椎板切除术加椎弓根螺钉固定虽能维持脊柱稳定性，但可能会减小脊柱活动度（ROM），还会引发许多其他并发症。本研究的目的是确定作为胸腰椎硬脊膜内肿瘤新手术方法的椎板成形术在保留脊柱ROM、维持脊柱稳定性及减少术后并发症方面是否优于椎板切除术。（2）方法：我们回顾性分析了50例行硬脊膜内肿瘤切除术的患者，其中23例行传统椎板切除术加椎弓根螺钉固定，27例行新的椎板成形术。通过腰椎屈伸位X线片和生物力学评估来评价脊柱ROM。通过对脊柱Cobb角和椎板骨融合的影像学观察来评估脊柱稳定性。根据脑脊液（CSF）漏出情况和住院时间来评估术后并发症。（3）结果：与椎板切除术组相比，椎板成形术组患者的脊柱ROM更佳（31.6±12.0°对21.7±11.8°，P = 0.013），Cobb角更小（9.6±4.3对12.5±5.3，P = 0.034），CSF漏出发生率更低（4/14.8%对11/47.8%，P = 0.015），住院时间更短（13.1±1.8天对15.1±2.3天，P = 0.001）。椎板成形术组的大多数患者骨融合情况良好。生物力学实验也表明椎板成形术的脊柱ROM大于椎板切除术组。（4）结论：与传统手术相比，新的椎板成形术能更好地维持脊柱稳定性，保留脊柱ROM，并减少术后并发症。它是一种可在临床上推广的手术方法。
