Bone-to-bone ligament preserving laminoplasty technique for reconstruction of laminae

Laminoplasty is a method used in spinal intradural tumor surgery to reduce the possibility of iatrogenic deformity. In classic laminoplasty, the interspinous, supraspinous, and ligamentum flavum integrity may be impaired, thereby creating a risk of deformity despite the laminoplasty. The aim of this study was to review the outcomes of bone-to-bone ligament preserving laminoplasty (BLP laminoplasty) technique.

The data of 14 cases who underwent BLP laminoplasty for intradural spinal tumor between 2017 and 2019 were reviewed. Through examination of preoperative and postoperative computed tomography images and flexion-extension lateral X-rays, the fusion and kyphotic changes were evaluated in the laminas. An axial Visual Analog Scale (VAS) was used to evaluate clinical satisfaction.

The cases comprised 10 females and 4 males, with a mean age of 39.2 years (range, 16-52 years). The masses were intramedullary in six cases and extramedullary in eight. Lumbar region localization was most frequent. Ependymoma was determined in 8 cases, schwannoma in 4, and meningioma in 2. Laminoplasty was applied at 43 levels (10 thoracic and 33 lumbar). No complications were observed, and fusion was obtained in all the cases at the end of 1 year. No segmental kyphotic changes were determined. In the clinical evaluation, the VAS scores improved from 3.4 ± 2.0 preoperatively to 1.8 ± 2.1 postoperatively.

BLP laminoplasty is a safe technique which preserves posterior ligamentous integrity. Furthermore, the use of ultrasonic bone scalpel provides a narrower gap between laminae and other bones, preventing dislocation, and allowing for more fusion, and consequently preventing kyphosis.