A Comparative Study of Spinous Process Splitting Laminectomy and Laminoplasty for Thoracolumbar Intradural Spinal Tumor Surgery.

Abstract

Background and objectives: In intradural spinal tumor surgery, laminoplasty (LP) aims to better preserve posterior spinal structures compared with laminectomy, potentially reducing complications such as deformity and cerebrospinal fluid leakage. Spinous process splitting laminectomy (SPSL), a modified form of laminectomy, also maintains the integrity of posterior spinal elements. However, there is concern regarding postoperative fluid collection at the laminectomy site. This study aimed to compare the postoperative outcomes between the two techniques.

Methods: This retrospective study included patients who underwent thoracolumbar intradural tumor surgery performed by a single experienced surgeon. Patients with instrumentation, hemilaminectomy, or reoperation for the same lesion were excluded. The volume of postoperative fluid collections and the degree of thecal sac compression caused by these collections on sagittal MRI were evaluated. Postoperative complications, along with other surgical and clinical outcomes were compared between groups. In addition, risk factors of cord compression were analyzed.

Results: A total of 149 patients underwent SPSL (n = 78) or LP (n = 71), with similar baseline characteristics. The mean volume of postoperative fluid collection per level was significantly larger in the SPSL group than in the LP group (P < .01, 95% CI [1.087, 2.858]). However, because the fluid passively accumulated in the dead space at the laminectomy site, the degree of thecal sac compression did not differ significantly (P = .536). Complication rates and neurological outcomes were comparable, although one SPSL patient required reoperation for symptomatic epidural hematoma and one LP patient for cerebrospinal fluid leakage. Changes in sagittal alignment parameters did not differ between groups. Fluid collection volume was not a risk factor of cord compression, but older age was (P = .01, 95% CI [1.01, 1.09]).

Conclusion: SPSL and LP demonstrated similar clinical and radiological outcomes. Although SPSL technique resulted in a larger volume of postoperative passive fluid collections at the laminectomy site, it did not lead to worse outcomes.