STUDY DESIGN: A prospective study of patients whose spinal cord tumors were managed surgically with a unique posterior method of removing and replacing the posterior spinal elements using T-saw ("recapping T-saw laminoplasty"). OBJECTIVES: To examine the safety and efficacy of the recapping T-saw laminoplasty technique for spinal canal surgery. SUMMARY OF BACKGROUND DATA: Laminectomy, laminoplasty, and/or laminotomy typically are used to approach intraspinal lesions. When removal and replacement of the posterior elements have been attempted, the effectiveness of the technique has been limited by the amount of bone sacrificed when using burrs or osteotomes. The authors thought to adapt a unique "threadwire saw" (T-saw) in these cases, because its use results in minimal bone loss. METHODS: Patients underwent recapping T-saw laminoplasty in the thoracic or lumbar spine for extirpation of spinal cord tumors. The T-saw was used for division of the posterior elements. After resection of the lesion, the excised laminae were replaced exactly in situ to their original anatomic position. The mean follow-up period was 47 months (range, 31-71 months). Patients were observed neurologically and radiologically. RESULTS: One to eight laminae were excised and replaced in 24 patients. Findings on computed tomography scans confirmed primary bony union in 23 patients by 6 months after surgery, and in one patient by 12 months after surgery. No complications such as postoperative spinal canal stenosis, facet arthrosis, or kyphosis were observed. CONCLUSIONS: Recapping laminoplasty afforded anatomic reconstruction of the vertebral arch after excision of spinal cord tumors. This procedure appears to warrant further evaluation as an alternative to wide laminectomies for exposure of intraspinal tumors. 相似文献
Total en bloc spondylectomy (TES) for vertebral tumour was previously reported by Tomita through a single posterior approach
using a T-saw. A modified total en bloc spondylectomy (MTES) technique is reported in the present study. The disc puncture
needle with a sleeve was used to obliquely puncture from the posterior to the anterior direction. A T-saw was inserted through
the sleeve and led out to the operator’s side by the leading clamp. The disc was partially cut with the saw from its medial
to lateral aspect. After a spinal fixation rod was applied on the operator’s side, the residual discs on the opposite side
were cut as described above. Six patients with thoracic vertebral tumours were operated on using the MTES technique. Five
patients showed improvement in their neurological deficits postoperatively. There was no evidence of tumour recurrence at
the final follow-up. The MTES is technically feasible with improved practicality and safety. 相似文献
We reported the surgical outcomes of total en bloc spondylectomy (TES) with intralesional T-saw transpedicular osteotomy in patients with Enneking stage III spinal giant cell tumors (GCTs).
Methods
The medical records and imaging and pathological studies of 25 consecutive patients with Enneking stage III spinal GCTs undergoing surgery at our institution who were followed for at least 2 years were retrospectively reviewed.
Results
Eight men and 17 women (mean age: 34.2 years, range 16–51 years, at the time of surgery) were included. Six patients underwent previous tumor excision at another hospital, and one patient had a history of denosumab treatment. The GCTs were at the cervical, thoracic, and lumbar levels in three, nine, and 13 patients, respectively. TES was performed in 13 patients; 12 required intralesional pediculotomy. The remaining patients underwent total piecemeal spondylectomy with further intralesional tumor resection. During a mean follow-up of 99.2 months (range 24–216), two patients who underwent total piecemeal spondylectomy had local tumor recurrence, but no patients who underwent TES with intralesional pediculotomy had recurrence. The 2- and 10-year recurrence-free survival rates of patients treated with total piecemeal spondylectomy were 91.7% and 78.6%, respectively, while those of patients treated with TES were both 100%.
Conclusions
TES with intralesional pediculotomy had a good surgical outcome even in patients with Enneking stage III spinal GCT, suggesting that minimal intralesional procedures could radically cure spinal GCTs.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Total en bloc spondylectomy (TES) is an important surgical treatment for spinal tumors that can achieve en bloc resection of the affected vertebral body by using the T-saw. However, the conventional TES process and the surgical instruments currently in use have some inconveniences, which may lead to longer operative times and a higher incidence of complications. To address these obstacles, we developed a modified TES technique using a homemade intervertebral hook blade. The objectives of this study were to describe our modified total en bloc spondylectomy (TES) using a homemade intervertebral hook blade and to assess its clinical effects in patients with spinal tumors.
Methods
Twenty-three consecutive patients with spinal tumors were included from September 2018 to November 2021. Eleven patients underwent a modified TES using an intervertebral hook blade, and 12 patients underwent a conventional TES using a wire saw. Details of the modified technique for TES were depicted, and the intraoperative blood loss, operative time, and improvement in pain symptom and neurological function measured by visual analog score (VAS) and American Spinal Injury Association (ASIA) score of all patients was reviewed and analyzed. Nonparametric analysis of covariates (ANCOVA) was performed to compare the clinical outcomes between patients treated with modified TES and conventional TES.
Results
The modified TES significantly reduced operative time (F = 7.935, p = 0.010) and achieved favorable improvement of neurological function (F = 0.570, p = 0.459) and relief of pain (F = 3.196, p = 0.088) compared with the conventional TES group. The mean intraoperative blood loss in the modified TES group (2381.82 ml) was lower than that in the conventional TES group (3558.33 ml), although the difference was not statistically significant (F = 0.677, p = 0.420).
Conclusions
Modified TES using the intervertebral hook blade can effectively reduce the operation time and intraoperative bleeding, and meanwhile ensure the improvement of neurological function and relief of pain symptoms, suggesting that this modified technique is feasible, safe, and effective for spinal tumors. 相似文献
OBJECTIVE: To introduce a method for a simple, nonexpansive laminoplasty that can be performed with a threadwire saw (T-saw) after en bloc laminotomy has been performed. The method can be applied along the entire spinal region, including the thoracic and lumbar spine. METHODS: An en bloc laminotomy of trapezoid shape at the cross section is performed bilaterally at the junctional area of the lamina and facet joint with a thin, flexible T-saw, while preserving the supraspinous, interspinous, and interlaminar ligaments. After the intradural procedure has been performed, the laminar flap is replaced in its original site and fixed with 1-0 nylon sutures, resulting in the complete reconstruction of the posterior supporting elements of the spinal column. RESULTS: En bloc laminoplasty was performed on 16 patients via a T-saw; most of the patients had intradural spinal tumors. The patients did not need their spinal canals to be enlarged after the intradural procedure had been performed. The follow-up period ranged from 2 to 40 months (mean +/- standard error, 22.6 +/- 3.4 mo). The laminoplasty was performed from the upper cervical to the sacral regions, although the most frequently operated level was the lower thoracic level. Two-level laminoplasty was performed in 12 patients, and three-level laminoplasty was performed in four. The laminoplasty was done safely and without any complications, except in one patient, who experienced thoracic root injury from a T-saw that was accidentally inserted anterior to the roots. No spinal column deformity or sinking of the replaced laminar flap was noted during the follow-up period; patients were assessed at follow-up via radiographs or computed tomographic scans. Computed tomographic scans obtained later indicated that bony fusion occurred at the cutting edges 1.0 to 4.0 months after surgery (mean, 1.90 +/- 0.34 mo). CONCLUSION: Simple en bloc laminoplasty performed with a T-saw is a useful, safe procedure that can be used to reconstruct the posterior spinal elements throughout the whole spinal region after the intradural procedure has been performed. 相似文献
In the field of spinal tumors, intralesional tumor cutting is sometimes inevitable. The purpose of this study was to compare
the potential for tumor growth after intralesional cutting by T-saw, Gigli saw, and scalpel. Tumors, prepared by the subcutaneous
injection of human HT 1080 fibrosarcoma cells in nude mice, were harvested and cut with a T-saw, Gigli saw, or scalpel. A
3-cm wound was created in the skin on the back in another group of nude mice. The cut surface of the tumor was rubbed for
10 s against the subcutaneous tissue in this second group of nude mice. In the same manner, the instrument used for tumor
cutting was rubbed against the subcutaneous tissue in the 3-cm wound in the back of a third group of nude mice for 10 s. Other
instruments used for tumor cutting were immediately washed in culture medium, and the total number of tumor cells was counted.
Tumor blocks and single-cell suspensions prepared from tumor tissues of the same weight were inoculated and injected into
a fourth group of nude mice. The incidence of tumor growth after the rubbing of the subcutaneous tissue with the tumor surface
cut with a T-saw, Gigli saw, and scalpel was 16.7%, 50.0%, and 33.3%, respectively. The corresponding figures after the rubbing
of the subcutaneous tissue with a T-saw, Gigli saw, and scalpel was 16.7%, 33.3%, and 33.3%, respectively. The mean numbers
of tumor cells attached to the T-saw, Gigli saw, and scalpel were 1.88 × 105, 5.02 × 105, and 4.92 × 105, respectively. Finally, the incidence of tumor growth after the inoculation of tumor blocks and single-cell suspensions was
100% and 77.8%, respectively. These findings show that tumor recurrence is less likely after intralesional tumor cutting with
a T-saw than after such cutting with a Gigli saw or scalpel.
Received: January 25, 2001 / Accepted: April 16, 2001 相似文献
