Extensive Multilevel Split Laminotomy for Debulking a Cervicothoracolumbar Nondysraphic Intramedullary Spinal-Cord Lipoma in a 2-Month-Old Infant.
BACKGROUND
Laminectomy is the traditional approach for posterior exposure of the spinal canal for tumor resection. Another technique is split laminotomy, which entails the division and retraction of the spinous processes and laminae to access the thecal sac. This technique has been employed for small-segment exposures, but not extensively explored for long-segment exposures.


METHODS
A 2-month-old male presented with progressive right-leg plegia. MRI of the spine revealed a large, intramedullary spinal-cord lipoma extending from C6 to L5. Surgical debulking was recommended to prevent further neurological deterioration. The patient underwent a split laminotomy (C6 to L5) for the debulking of the spinal lipoma. Complete resection was not pursued; rather, the goal was complete decompression. Postoperatively, the patient exhibited good upper-extremity strength but minimal lower-extremity movement; the latter had progressively improved by the time he was discharged. The patient was extubated and tolerated oral intake. Urological evaluation noted a high-pressure bladder with neurogenic overactivity; he was started on intermittent catheterization with anticholinergic medication. He was placed in a custom brace with instructions to wear the brace for 20 h per day. At the 2-year follow-up, the patient exhibited a persistent left-foot contracture deformity and weakness requiring an orthosis. Serial films demonstrated no abnormal deformity at 11 months but notable progression of kyphosis and scoliosis at 30 months.


CONCLUSIONS
For multilevel posterior exposure of the spinal canal, split laminotomy is an alternative that can provide adequate exposure for midline lesions without disrupting the paraspinal musculature. Longer-segment exposures, especially spanning the cervical to lumbar levels, may still elicit kyphosis and scoliosis. As such, long-term follow-up remains necessary.
Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Ha Son
HS
Nguyen
Sean
S
Lew
D065426:Cytoreduction Surgical Procedures; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D007796:Laminectomy / Q000379:methods*; D007866:Leg; D008067:Lipoma / Q000601:surgery*; D008297:Male; D010243:Paralysis / Q000209:etiology; D013115:Spinal Canal / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
Scoliosis; Spinal lipoma; Split laminotomy