The lamina-spinous process-ligament complex implantation for the spinal stability: A case report and review of literature.

Abstract

Rationale: The posterior cervicothoracic fusion is a common surgical skill for the treatment of spinal diseases. Since postoperative complications contribute to compressive neurological symptoms, this case is reported to provide a surgical option for the preservation of spine stability and bone fusion.

Patient concerns: A 36-year-old male presented numbness of both lower limbs for more than half a year, accompanied by unstable walking for more than 2 months.

Diagnoses: Clinical examination revealed grade 4 muscle strength of both lower extremities, low muscle tension, loss of abdominal wall reflex, cremasteric reflex and anal reflex, and unsteady gait. Magnetic resonance imaging suggested a 5th cervical vertebrae-2nd thoracic vertebrae (C5-T2) intramedullary space-occupying mass.

Interventions: Written informed consent was obtained from the patient before surgery. To relieve his symptom and preserve spine stability, we performed an operation to remove the C5-T2 intramedullary ependymoma. Meantime, the laminae-spinous process complex was replanted and fixed in situ.

Outcomes: Magnetic resonance imaging indicated that the tumor was completely resected. There are no delayed bleeding and instances of implant loosening. There were no tumor recurrence, spinal stenosis, spinal instability, and spondylolisthesis, and part of vertebral laminae have formed bony healing.

Lessons: Our case suggests that the in situ preservation of supraspinous ligament longitudinal continuity of lamina-spinous process-ligament complex implantation skill will provide a surgical option for the preservation of spine stability and bone fusion in patients with long-segment intraspinal tumors.