Why is laminectomy usually an inadequate procedure for treatment of a metastatic spinal lesion

In patients with neurologic deficit due to metastatic spinal lesions, 70% have anterior tumor compressing the dural sac, 20% have lateral compression of the dural sac, and only 10% have posterior neural compression by tumor mass. Inadequate decompression of the anterior spinal canal is obtained by a laminectomy. Furthermore, the destabilization of the spinal column created by a laminectomy increases the risk of postoperative spinal cord compression and paraplegia due to the development of postoperative kyphotic deformity and increased spinal instability. The primary indication for laminectomy as a stand-alone procedure is the relatively uncommon presentation of posterior epidural compression by metastatic tumor in a patient without anterior spinal column involvement by tumor.

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