Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients.
OBJECTIVE
Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution.


METHODS
We retrospectively reviewed the records of 238 consecutive patients undergoing resection of intradural tumor at a single institution. The incidence of subsequent progressive kyphosis or scoliosis, perioperative morbidity, and neurological outcome were compared between the LP and LM cohorts.


RESULTS
One hundred eighty patients underwent LM and 58 underwent LP. Patients were 46 +/- 19 years old with median modified McCormick score of 2. Tumors were intramedullary in 102 (43%) and extramedullary in 102 (43%). All baseline clinical, radiographic, and operative variables were similar between the LP and LM cohorts. LP was associated with a decreased mean length of hospitalization (5 vs 7 days; P = .002) and trend of decreased incisional cerebrospinal fluid leak (3% vs 9%; P = .14). Following LP vs LM, 5 (9%) vs 21 (12%) patients developed progressive deformity (P = .728) a mean of 14 months after surgery. The incidence of progressive deformity was also similar between LP vs LM in pediatric patients < 18 years of age (43% vs 36%), with preoperative scoliosis or loss of cervical/lumbar lordosis (28% vs 22%), or with intramedullary tumors (11% vs 11%).


CONCLUSIONS
LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.
McGirt
Matthew J
MJ
Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. mmcgirt1@jhmi.edu
Garcés-Ambrossi
Giannina L
GL
Parker
Scott L
SL
Sciubba
Daniel M
DM
Bydon
Ali
A
Wolinksy
Jean-Paul
JP
Gokaslan
Ziya L
ZL
Jallo
George
G
Witham
Timothy F
TF
D002648:Child; D006801:Humans; D015994:Incidence; D007738:Kyphosis / Q000453:epidemiology* / Q000209:etiology; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology* / Q000209:etiology; D013120:Spinal Cord Neoplasms / Q000601:surgery*