Abstract：Objective To explore the effectiveness and safety of para-split laminotomy in lumbar spinal canal surgery through an anatomical study.Methods Ten adult cadaver specimens fixed with 10% formalin were included in this study.(1)Four specimens were selected, all the vertebral units from the L1-5 vertebrae (20 cases) were taken out. The widths of the exposed vertebral canal bottom wall were measured when the unilateral lamina of each vertebral unit was cut and stretched to 8 mm, 10 mm and 12 mm in turn. To continue stretching to make vertebral fracture of each unit, the location of fracture and the distance of distraction should be recorded. (2)In the other 6 specimens, a simulated operation of para-split laminotomy was performed with the L1 and L2 vertebrae as the target segments. The laminas were cut and stretched to 8 mm, 10 mm and 12 mm, the anatomical structures in the spinal canal were observed and recorded. After that, the paravertebral muscles of the spine were removed to confirm whether there was fracture of the operative segment, tear of the adjacent ligaments and articular capsules.Results (1) When the distraction distance was 8 mm, 10 mm and 12 mm, the average exposure width of the bottom wall of the vertebral canal was (10.63±0.59) mm, (13.92±0.79) mm and (17.81±1.10) mm respectively. Statistical analysis showed that the significant difference existed between any two groups (F=18.260, P＜0.01). After measurement, the widths of vertebral unit fracture caused by distraction were 11.8-16.5 (14.26±1.34) mm. Among them, 5 cases suffered from ipsilateral pedicle fracture, 4 cases from contralateral lamina fracture, and 11 cases from contralateral pedicle fracture. (2) In the 8 mm group, the operation experiments could not be completed because of limited operating space. In the 10 mm group and 12 mm group, all the procedures including the incision and suture of spinal dura mater and full exploration of cauda equine, could be performed. The latter had a higher degree of freedom than the former. After the simulated operation, neither vertebral fracture nor tear of ligament or capsule was found.Conclusions The application of the para-split laminotomy is feasible and effective to expose and explore the internal structures of lumbar spinal canal. It may be relatively safe and effective when the lamina is distracted from 10 mm to 12 mm.
张恒柱, 许智闻, 王晓东, 严正村, 佘磊, 李育平. 腰椎经旁正中椎板切开复位术有效性及安全性的解剖学研究[J]. 中华解剖与临床杂志, 2019, 24(6): 549-553.
Zhang Hengzhu, Xu Zhiwen, Wang Xiaodong, Yan Zhengcun, She Lei, Li Yuping. Anatomical study on the effectiveness and safety of para-split laminotomy in lumbar spinal canal surgery. Chinese Journal of Anatomy and Clinics, 2019, 24(6): 549-553.
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2019, Vol. 24 
