Decompressive Laminectomy Alone for Degenerative Lumbar Scoliosis with Spinal Stenosis: Incidence of Post-Laminectomy Instability in the Elderly

Kee-Yong Ha,Young-Hoon Kim,Sang-Il Kim,Hyung-Youl Park,Jeung-Hwan Seo 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4

Background: Decompressive laminectomy alone for degenerative lumbar scoliosis (DLS) is not recommended because it can lead to further instability. However, it is uncertain whether instability at the decompressed segments is directly affected by laminectomy or the natural progression of DLS. The purpose of this study was to evaluate the surgical outcome of decompressive laminectomy alone for DLS with spinal stenosis and to determine whether the procedure leads to post-laminectomy instability (PLI). Methods: We retrospectively reviewed 60 patients with DLS. They were divided into 2 groups according to PLI criteria: stable group and PLI group. The PLI group was subdivided into 2 groups based on the level of PLI: the first group that showed PLI at the index laminectomy level (PLI-I) and the second group that showed PLI at another level other than the laminectomy level (PLI-NI). Radiological evaluation was performed to determine factors associated with the progression of DLS. Pain and disability outcomes were assessed. Results: There were 34 patients (56.7%) in the stable group and 26 patients (43.3%) in the PLI group. Twelve patients (20.0%) underwent revision surgery. Eleven patients (18.3%) showed PLI at the index segments (PLI-I group), and 15 patients (25%) showed PLI at the adjacent or cephalad segments, not related to the laminectomy site (PLI-NI group). Four patients underwent revision surgery in the stable group and 8 in the PLI group. Survivorship analyses revealed that the predicted survivorship of DLS was 90.0% at 12 months and 86.4% at 24 months after laminectomy. Conclusions: The development of PLI was not always related to laminectomy at the index level. However, PLI developed more rapidly at the index level, compared to the natural progression of the scoliotic curve at the adjacent segments.

Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

Masashi Uehara,Jun Takahashi,Hiroyuki Hashidate,Keijiro Mukaiyama,Shugo Kuraishi,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Nobuhide Ogihara,Hiroki Hirabayashi,Hiroyuki Kato 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. Purpose: Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches. Overview of Literature: There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy. Methods: This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. Results: Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p -values, in the splitting group compared to the conventional group: average operating time (p =0.002), postoperative C-reactive protein level (p =0.006), the mean postoperative number of days until returning to normal body temperature (p =0.047), and the mean change in angulation 2 years postoperatively (p =0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. Conclusions: In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy.

Chitosan-Hydroxyapatite Scaffold for Tissue Engineering in Experimental Lumbar Laminectomy and Posterolateral Spinal Fusion in Wistar Rats

Martin Rodríguez-Vázquez,Rodrigo Ramos-Zúñiga 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.2

Study Design: Experimental study with an animal model. Purpose: To evaluate the role of a chitosan and hydroxyapatite composite for spinal fusion in a lumbar experimental model based on regenerative tissue engineering principles. Overview of Literature: Chitosan and hydroxyapatite represent an alternative biodegradable implant material for tissue engineering and regeneration. The combination of chitosan and hydroxyapatite in a 20:80 ratio could potentiate their individual properties as an implantable composite for experimental laminectomy. Methods: Phase I: design and synthesis of a porous composite scaffold composed of chitosan-hydroxyapatite using a freeze drying technique. Phase II: experimental microsurgical lumbar laminectomy at L5. A total of 35 Wistar rats were categorized into three experimental groups: control (laminectomy alone), experimental (laminectomy with implant), and reference (intact spine) (n=5 per group). Postoperative structural and functional evaluations were performed using computed tomography scans. In addition, radiologic, clinical, histological, and immunohistochemical microstructures were evaluated. Results: At the laminectomy site, the composite implant induced bone regeneration, which was observed in the axial reconstruction of the rat lumbar spine in all cases. Biomechanical changes in the lumbar spine were observed by radiology in both groups after the surgery. The posterolateral space was covered by a bone structure in the treated spine, a condition not seen in the control group. The range of motion was 7.662°±0.81° in the scaffold group versus 20.72°±3.47° in the control group. Histological findings revealed qualitatively more bone tissue formation in the implant group. Conclusions: A composite of chitosan-hydroxyapatite at a 20:80 ratio induced bone formation after experimental laminectomy in rats and led to spinal fusion, which was assessed by radiology and biomechanical tests. No functional complications in posture or walking were observed at 90 days post-surgery, despite biomechanical changes in the spine.

단분절 요천추 유합술 후 상위 인접 분절의 방사선학적 변화-과연 후궁 전 절제술이 상위 인접 분절 불안정성을 야기하는가?

황대우,신재흥,김병민,박영수,이정희,김응하 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.1

Study Design:Retrospective study. Objectives:The purpose of this study was to compare factors that influence degenerative changes in patients undergoing totallaminectomy and patients undergoing partial laminectomy. Summary of Literature Review:Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent seg-ment problems of the upper segment. However, the differences between the two procedures that may influence adjacent seg-ment instability are still controversial. Materials and Methods:We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (atmost 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment proceduresincluded total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the interverte-bral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and lastfollow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation.However, we included cases that required revision due to adjacent segmental problems during the follow-up period. Results:The mean age of the patients treated with total laminectomy was 59.0± 10.9 years, and of the patients treated withpartial laminectomy was 58.8± 10.2 years. The preoperative Thompson grade showed no statistical difference. The difference indisc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical dif-ference between the two groups. Conclusions:There was no significant difference in the radiographic or clinical outcomes based on removal or preservation ofposterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.

Removal of Intradural-Extramedullary Spinal Cord Tumors with Unilateral Limited Laminectomy

Sim, Jong-Eun,Noh, Seung-Jin,Song, Young-Jin,Kim, Hyung-Dong The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.43 No.5

Total laminectomy for the removal of intradural-extramedullary spinal cord tumors has been used widely, but postoperative complications often develop, such as kyphosis, spinal instability, and persistent back pain. In this study, we evaluated seven patients with intradural-extramedullary spinal cord tumors with respect to the value of unilateral limited laminectomy. Our cases included six schwannomas, and one meningioma. The cervical region was involved in four cases, the thoracolumbar region in two cases, and the lumbar region in one case. The rationale for choosing a unilateral approach is to preserve musculoligamentous attachments and posterior bony elements as much as possible. The patients were mobilized on the third postoperative day and preoperative neurological symptoms were recovered within a few weeks. We did not observe any complication relating to unilateral limited laminectomy and at follow-up evaluation (at 3 and 12 months postoperatively), none of the patients showed spinal deformity or spinal instability. We think that the unilateral limited laminectomy is a safe and efficient technique for the treatment of intradural-extramedullary spinal cord tumors. We suggest that this technique is one of the best treatments for these tumors.

Postoperative Non-Pathological Fever Following Posterior Cervical Fusion Surgery : Is Laminoplasty a Better Preventive Method than Laminectomy?

Lee, Subum,Jung, Sang Ku,Kim, Hong Bum,Roh, Sung Woo,Jeon, Sang Ryong,Park, Jin Hoon The Korean Neurosurgical Society 2020 Journal of Korean neurosurgical society Vol.63 No.4

Objective : To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). Methods : This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38℃ on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. Results : Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. Conclusion : Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

Minimally Invasive Removal of an Intradural Cervical Tumor : Assessment of a Combined Split-Spinous Laminectomy and Quadrant Tube Retractor System Technique

Kwak, Young-Seok,Kim, Kyoung-Tae,Cho, Dae-Chul,Kim, Young-Baeg The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.4

Conventional laminectomy is the most popular technique for the complete removal of intradural spinal tumors. In particular, the central portion intramedullary tumor and large intradural extramedullary tumor often require a total laminectomy for the midline myelotomy, sufficient decompression, and adequate visualization. However, this technique has the disadvantages of a wide incision, extensive periosteal muscle dissection, and bony structural injury. Recently, split-spinous laminectomy and tubular retractor systems were found to decrease postoperative muscle injuries, skin incision size and discomfort. The combined technique of split-spinous laminectomy, using a quadrant tube retractor system allows for an excellent exposure of the tumor with minimal trauma of the surrounding tissue. We propose that this technique offers possible advantages over the traditional open tumor removal of the intradural spinal cord tumors, which covers one or two cervical levels and requires a total laminectomy.

요추척추궁 절제술 환자의 표준관리지침서 개발

박재정,박형숙 성인간호학회 2000 성인간호학회지 Vol.12 No.4

The purpose of this study was to develop a critical pathway for case management of patients who have received Lumbar Laminectomy because of low back Pain, arm and le9 numbness, and radiating pain in the leg. For this study a preliminary critical pathway was developed through a review of the literature including five critical pathways which are currently being used in the USA. In order to identify the overall service contents required by these Patients. 30 cases were analyzed. These cases were taken from medical records of those with Lumbar Laminectomy between January. 1998 and December, 1998 in the department of neurosurgery at the Pusan National University Hospital in Pusan. An expert validity test was done for the preliminary critical pathway, a clinical validity test was also done using 12 patients with Lumbar Laminectomy between October 1, 1999 and January 31, 2000. After these Processes, the final critical pathway was developed. The results are summarized as follows. 1.The vertical axis of the critical pathway includes the following eight items: assessment, consultation, diet, test, medication treatment, activity, ducation/discharge planning. The horizontal axis includes the time from the start of hospitalization to discharge. Analysis of the 30 medical records was done. analysis of the service contents showed the horizontal axis of the preliminary critical pathway was set from hospitalization to the 12th post operation day and the vertical axis was set to include eight items, the contents which should have occurred according to the time frames of the horizontal axis. 2.As a result of the expert validity test, it was found that among the 233 items, 203 showed over 88% agreement and 30 of them showed less than 88% agreement. which were then revised or deleted from the critical pathway. At the preliminary meeting for the clinical validity test, the time of hospitalization on the horizontal axis was shortened to the 10th post operation day. A clinical validity test was done with 12 patients with Lumbar Laminectomy. All the cases progressed according to the critical pathway although some variances were noted in assessment, consultation, test, medication, and treatment. 3.Based on these results, a final critical pathway was determined. In conclusion, this critical pathway is partially applicable to the care of Patients with Lumbar faminectomy and needs further investigation.

Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model

Choi, Hyu-Jin,Kim, Kyoung-Beom,Kwon, Young-Min The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.49 No.6

Objective : Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. Methods : A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. Results : The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. Conclusion : This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.

Post-Laminectomy Kyphosis in Patients with Cervical Ossification of the Posterior Longitudinal Ligament : Does It Cause Neurological Deterioration?

Cho, Won-Sang,Chung, Chun-Kee,Jahng, Tae-Ahn,Kim, Hyun-Jib The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.43 No.6

Objective : Total laminectomy (TL) is an effective surgical technique for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) along multiple levels. However, kyphosis and probable neurological deterioration have been frequently reported after laminectomy. We analyzed the changes in the cervical curvature after TL and subsequent changes in neurological status. Methods : We retrospectively reviewed the records of 14 patients who underwent TL for the treatment of cervical OPLL between Jan. 1998 and Dec. 2003. TL was selected according to the previously determined criteria. The curvature of the cervical spine was visualized on a lateral cervical spine X-ray and measured using Ishihara's Curvature Index (CI) before the operation and at the last follow-up examination. Perioperative neurological status was estimated using the modified Japanese Orthopedic Association score and the Improvement Rate (IR) at the same time as the images were evaluated. Results : The mean age of the patients was 57 years, the male/female ratio was 10:4, and the mean follow-up period was 41 months. The mean number of OPLL was 4.9, and the mean number of operated levels was also 4.9. The CI decreased after TL (p=0002), which was indicative of a kyphotic change. However, this kyphotic change showed no correlation with the length of the follow-up period, number of operated levels and preoperative CI. Neurological examination at the last follow-up showed an improved neurological status in all patients (p=0.001). There was no neurological deterioration in any case during the follow-up period. Moreover, there was no correlation between IR and the degree of kyphotic change. Postoperative complications, such as C5 radiculopathy and epidural bleeding, resolved spontaneously without neurological sequelae. Conclusion : Kyphotic change was observed in all but one patient who underwent TL for the treatment of cervical OPLL. However, we did not find any contributing factors to kyphosis or evidence of postoperative neurological deterioration.