Hemilaminectomy versus laminoplasty for intradural extramedullary tumors: A comparison of postoperative axial pain and regional outcomes

Abstract

Objective: Intradural extramedullary (IDEM) tumor surgery traditionally focuses on gross total resection (GTR), but postoperative quality of life-specifically chronic axial pain-has emerged as a critical metric. Conventional laminoplasty, despite being restorative, involves bilateral muscle stripping that may cause persistent axial morbidity. Research question : This study investigated whether the unilateral, muscle-preserving approach of hemilaminectomy translates into superior long-term axial pain control compared to laminoplasty. Methods: We retrospectively reviewed 99 patients (Hemilaminectomy: 55; Laminoplasty: 44). To isolate the impact of surgical trauma, cases with significant facet violations or pre-existing instability were excluded. Axial and radiating pain (NRS) were assessed at 1, 6, and 12 months postoperatively. Results: Preoperative disc and facet degeneration were comparable between groups (p > 0.05). While radiating pain relief was equivalent, the hemilaminectomy group showed significantly lower axial pain at 6 months (1.54 +/- 1.89 vs. 2.58 +/- 1.79, p = 0.002) and 1 year (2.07 +/- 2.06 vs. 2.63 +/- 1.70, p = 0.049). This benefit was most pronounced in the thoracic subgroup, which showed superior 6-month axial pain control (p = 0.002) and continuous recovery from 1 month to 1 year (p = 0.028) compared to the laminoplasty group. Conclusion: Hemilaminectomy provides a distinct minimally invasive advantage by preserving the posterior midline structures and contralateral muscles. This structural integrity leads to a significant reduction in chronic surgery-induced axial pain compared to laminoplasty, particularly in the thoracic spine.