Study Design. A retrospective clinical follow-up study of patients who underwent intraspinal surgery with reconstruction of the laminar roof using titanium miniplates.
Objective. To evaluate the surgical technique of laminar roof reconstruction and to analyze follow-up results with regard to bony healing of the laminae and the development of spinal deformities.
Summary and Background Data. The reconstruction of the laminar roof was initially proposed to overcome adverse effects associated with extensive cervical laminectomy in children. Because technical evolutions such as the use of an air drill and miniplates have facilitated the procedure, it has gained more widespread use as a posterior approach for intraspinal surgery. Thus, with a sufficient number of patients treated and a longer period of follow up, it seems reasonable to critically evaluate the technique and its suitability as a standard approach for intraspinal surgery.
Methods. The surgical procedures of 79 patient who underwent intraspinal surgery with osteotomy and reconstruction of a total of 323 spinal laminae using an air drill and miniplates were analyzed. In 59 patients, data of a complete clinical and radiologic follow-up examination were evaluated. Plain radiographs and computed tomography scans were analyzed for bony healing of the laminae and spinal alignment.
Results. Minor complications such as cerebrospinal fluid collections and disturbed wound healing occurred within normal ranges. The was no case of dural, nerve root, or spinal cord injury attributable to laminotomy or laminar reconstruction. Eight (14.3%) patients complained of moderate to severe local pain at the time of follow-up examination and 8 patients stated impaired mobility of their spine at the surgical site. Bony healing was confirmed radiologically in 86.1% of the laminae. In 12 patients, a preexisting spinal deformity worsened after surgery and five patients demonstrated a new spinal malalignment. No patient required additional surgery because of progressive spinal deformity. Intramedullary location of the lesion and cervical location of surgery were significantly associated with the development of spinal malalignment, whereas incomplete bony healing of the laminae was not.
Conclusions. The reconstruction of the laminar roof using the technique described is safe, well suitable to serve as a standard posterior approach to intraspinal pathologies, and offers distinct advantages over laminectomy. However, some patients, particularly those with intramedullary cervical lesions, could develop spinal malalignment after surgery despite reconstruction of the laminar roof and sufficient bony healing of the laminae.
The reconstruction of the laminar roof aims to overcome the disadvantages of a simple laminectomy. The current study gives a detailed description of the surgical procedure and presents the results of a consecutive series of 79 patients who underwent osteotomy and reconstruction of a total of 323 spinal laminae. Considering complications and bony healing the results were overall satisfying. Osteoplastic laminotomy appears to be well suited to serve as a standard posterior approach to intraspinal pathologies, although spinal malalignment may occur in some cases despite sufficient bony healing.
From Neurochirurgische Klinik und Poliklinik, Universitätsklinikum Essen (UKE), and the Department of Neurosurgery, University of Essen, Essen, Germany.
Acknowledgment date: June 20, 2003. First revision date: October 7, 2003. Second revision date: November 18, 2003. Acceptance date: November 18, 2003.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work. No benefits of any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Address correspondence to Priv.-Doz. Dr. Helmut Wiedemayer, Universitätsklinikum Essen, Neurochirurgische Klinik, Hufelandstr. 55, 45122 Essen, Germany; E-mail: helmut.wiedemayer@uni-essen.de
