Unilateral hemilaminectomy for intradural spinal tumors: a 10-year retrospective cohort study

Single-center retrospective cohort study.

To evaluate tumor control, neurological recovery, perioperative morbidity, and long-term biomechanical stability of unilateral hemilaminectomy (UH) for adult intradural spinal tumors.

Total laminectomy disrupts stabilizing posterior elements and may necessitate instrumentation for deformity. UH preserves the contralateral posterior complex, offering comparable resection rates, reduced perioperative morbidity, and shorter hospitalization. However, most studies on UH involve small, methodologically heterogeneous samples, with limited long-term data on neurological recovery and mechanical stability without fusion.

Adult patients (≥18 years) undergoing UH for intradural spinal tumors (2015-2025) were retrospectively identified from a prospectively maintained database. Pediatric patients and those with extradural tumors were excluded. Primary endpoints were the extent of resection (gross total resection [GTR] vs. subtotal resection [STR]) and biomechanical stability (segmental instability or delayed fusion). Secondary outcomes included operative time, blood loss, length of stay, transfusion, postoperative complications, and unplanned reoperation. Neurological function (American Spinal Injury Association Impairment Scale [AIS] C/D vs. AIS E) was analyzed using Fisher's exact and McNemar tests. A focused literature review summarized comparative evidence on UH versus total laminectomy.

Of the 405 UH procedures screened, 136 adult intradural tumors met the criteria (108 extramedullary; 28 intramedullary). The average operative time, blood loss, and hospital stay were 91.0±13.5 minutes, 58.5±16.6 mL, and 3.97±1.05 days, respectively. One patient developed postoperative complications (cerebrospinal fluid leak requiring duraplasty); no transfusions or instrumented fusion were required. GTR was achieved in 95.6% cases; six intramedullary astrocytomas underwent STR followed by stereotactic radiotherapy. Neurological status improved significantly in extramedullary tumors (p<0.001), and no radiographic recurrence or delayed fusion occurred during follow-up.

UH allows high resection rates, neurological improvement, low morbidity, and durable mechanical stability in intradural tumors, supporting its use as a tissue-preserving alternative to wider posterior exposure.