Para-split laminotomy: a rescue technique for split laminotomy approach in exploring intramedullary midline located...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Techniques

Background:

• Conventional posterior approaches for midline intramedullary spinal pathologies risk spinal deformities and instability.
• Multilevel laminectomies and facetectomies can compromise spinal structures.
• A need exists for minimally invasive techniques that preserve posterior spinal stabilizers.

Purpose of the Study:

• To develop a minimally invasive rescue surgical technique for midline intramedullary spinal pathologies.
• To enable tumor removal without increasing the risk of damage to posterior spinal stabilizers.
• To offer an alternative when standard spinous process splitting is not feasible.

Main Methods:

• The para-split laminotomy technique was developed, accessing the spinal canal via a parasagittal plane.
• This technique was combined with the basic split laminotomy.
• It was applied to five adult patients with cervical and cervicothoracic intramedullary pathologies.

Main Results:

• The para-split approach provided sufficient surgical access for tumor removal.
• Resection extent and neurological outcomes were not compromised.
• No spinal instability was detected in patients post-surgery, despite moderate bony structure disturbance.

Conclusions:

• The multilevel para-split laminotomy is a safe and effective rescue technique for midline intramedullary pathologies.
• It minimizes damage to posterior spinal stabilizers and reduces vertebral arch/facet joint disintegration.
• This approach aligns with minimally invasive surgery principles, preserving spinal integrity.