Unilateral Hemilaminectomy for Intradural Lesions

Objective Unilateral hemilaminectomy ( UHIL ), an alternative surgical approach to intradural lesions, involves a unilateral approach to meningeal opening that provides an adequate window for tumor extraction while leaving most of the vertebral structures intact. The techniques and results of a modified hemilaminectomy technique with spinal endoscopy is discussed and limited unilateral hemilaminectomy for intradural tumors ( UHIT ) evaluated prospectively. Methods Relevant clinical variables, operative reports, histological findings, pre‐ and post‐operative imaging, and follow‐up data for 11 consecutive patients (five males, six females; mean age 63.36 ± 20.69 years) who underwent modified hemilaminectomy over a 3 year time period were analyzed. Contrast‐enhanced MRI was used to demonstrate the side, size and location of the suspected tumor or intradural lesion and CT to evaluate the bone anatomy. Post‐operative MRI and CT allowed evaluation of anatomy following resection. Results Lesions included meningiomas ( n = 2), neuromas ( n = 3), and metastases, cysts or gliomas ( n = 6). Pre‐operative indications in order of incidence included cord compression, claudication, lower back pain, radiculopathy, paraplegia, weakness, incontinence, and generalized neuro‐deterioration. There were no major complications, and no spinal deformity or instability at final follow up (mean, 13 months; range, 3–36 months). Conclusion Our data suggest that there is a place for the UHIT approach. This minimally invasive approach is useful for resecting all intradural tumors. UHIL is a useful minimally invasive technique for resecting intradural spinal tumors with maximal preservation of musculoligamentous attachments and posterior bony elements and should be considered an improvement on currently employed techniques.