• Journal of Korean Neurosurgical Society
• /
• 제50권3호
• /
• pp.195-200
• /
• 2011

Objective : To present the profiles of spinal cord tumors that can be removed through a unilateral hemilaminectomy and to demonstrate its usefulness for benign spinal cord tumors that significantly occupy the spinal canal. Methods : From June 2004 to October 2010, 25 spinal cord tumors were approached with unilateral hemilaminectomy. We calculated the cross-sectional occupying ratio (CSOR) of tumor to spinal canal before and after the operations. Results : The locations of the tumors were intradural extramedullary in 20 cases, extradural in 2, and intramedullary in 3. The levels of the tumors were lumbar in 12, thoracic 9, and cervical 4. In all cases, the tumor was removed grossly and totally without damaging spinal cord or roots. The mean height and width of the lesions we195re 17.64 mm (3-47.5) and 12.62 mm (4-32.7), respectively. The mean CSOR was 69.40% (range, 27.8-96.9%). Postoperative neurological status showed improvement in all patients except one whose neurologic deficit remained unchanged. Postoperative spinal stability was preserved during the follow-up period (mean, 21.5 months) in all cases. Tumor recurrence did not develop during the follow-up period. Conclusion : Unilateral hemilaminectomy combined with microsurgical technique provides sufficient space for the removal of diverse spinal cord tumors. The basic profiles of the spinal cord tumors which can be removed through the unilateral hemilaminectomy demonstrate its role for the surgery of the benign spinal cord tumors in various sizes.

• 대한미세수술학회:학술대회논문집
• /
• 대한미세수술학회 1996년도 제16차 학술대회
• /
• pp.175.2-176
• /
• 1996

• Journal of Korean Neurosurgical Society
• /
• 제39권1호
• /
• pp.40-45
• /
• 2006

Objective : To determine the relationship between the clinical outcome and the extent of surgical laminectomy for adequate decompression on the cases of cauda equina syndrome, the authors review and analyze their cases and compared with those of literatures. Methods : The authors reviewed 655 patients retrospectively who had underwent surgery on the cases of lumbar disc herniation from January 2000 to December 2004. There were 19 patients [2.9%] who presented for clinical cauda equina syndrome. Among them, we selected and analyzed 15 patients who were treated by unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy, and they had been followed from 5 weeks to 47 months postoperatively [mean, 13.47 months]. The levels of the disc herniations were L4-5 in 8 patients, following L5-S1 in 4 patients and 2 levels [L4-5 and L5-S1] in 3 patients. Motor and sensory recoveries were recorded. Postoperative urinary function recovery Was defined according to Gleave and Macfarlane. Results : In 12 months postoperatively, the bladder function was obtained in 14 of 15 patients[93%] with regaining urinary continence. Thirteen of 15 patients[86%] with preoperative motor weakness of lower extremities were recovered. Sensory deficit of lower extremities, perianal and saddle anesthesia were all recovered. Patients had recovered on lumbosciatic pain and saddle hypesthesia, in turn, motor function and urinary incontinence. Conclusion : In treating cauda equina syndrome, the authors did less extensive surgery, such as unilateral partial hemilaminectomy with discectomy or bilateral partial laminectomy with discectomy for adequate decompression. The outcome is satisfactory and comparable with those of subtotal or total laminectomy.

• 대한수의학회지
• /
• 제42권4호
• /
• pp.537-543
• /
• 2002

The purpose of the present study was to investigate structural stability of extensive laminectomy and the effect of subcutaneous fat autograft on restricting formation of postlaminectomy membrane (fibrous tissue). Eighteen healthy dogs of both sexes and of mixed breeding were divided into 6 groups : (1) unilateral hemilaminectomy (group H) on 3rd, 4th and 7th vertebrae ; (2) modified dorsal laminectomy (group D) on 3rd, 4th and 7th vertebrae. Hemilaminectomies were carried out incontinuously at 16 sites in 4 dogs, then subcutaneous fat autografts (group F) were applied to 8 laminectomy sites and no treatment (group C) was assigned to 8 laminectomy sites, too. Operating time of group H ($30.9{\pm}10.4$ minutes) was significantly shorter (p<0.05) than that of group D ($43.1{\pm}12.2$ minutes), but surgical hemorrhage of group H is severer than that of group D. General states, such as standing, gait, defecation and urination, were normal. Upper motor neuron/lower motor neuron signs were not found and superficial/deep pain, proprioception and anal sphincter tone were normal. Gross postmortem findings were similar in all groups. The laminectomy sites of groups H and D were filled with fibous connective tissue at 4 months after operation and histopathological abnormalities of spinal cord were not found. One of eight laminectomy sites in group F was filled with fibrous tissue at 2 months after operation, but all operating sites of group C were covered with fibrous tissue. The present study indicated that extensive laminectomy on 7 vertebrae, using unilateral hemilaminectomy and modified dorsal laminectomy technique, maintained structural stability and subcutaneous fat autograft was effective on reducing the formation of fibrous membrane in laminectomy sites.

• Journal of Korean Neurosurgical Society
• /
• 제37권6호
• /
• pp.410-415
• /
• 2005

Objective: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. Methods: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6 - 48months). Results: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was $52.5{\pm}19.9mm^2$ and $110.6{\pm}18.2mm^2$, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to $3.1{\pm}1.2$. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. Conclusion: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.