206. Multilevel Split Laminotomies for Excision of Spinal Dermal Sinus Tracts

Authors: Benjamin Best, MD; Andrew Montoure, MD; Sean Lew, MD (Milwaukee, WI)

Introduction:
Complete excision of dermal sinus tracts frequently requires multilevel spinal exposure. The traditional approach is via multilevel laminectomies.  The split laminotomy is a technique that accesses the spinal canal in the midline without requiring exposure of the laminae or violation of the paraspinal muscular attachments and innervation. It has previously been shown to result in less paraspinal muscle atrophy and decreased postoperative pain medication requirement compared to conventional laminectomy.  Children with dermal sinus tracts are excellent candidates for the split laminotomy approach due to: a) young age (the technique is easier in children as the exposure isn’t as deep and the bone is more-easily distractable); b) the midline nature of dermal sinus tracts (the main limitation of split laminotomy is the limited lateral exposure); c) the frequent need for multilevel exposure for complete excision of the tract; and d) the benefit in maintaining the integrity of the spinal column in the growing spine. Split laminotomy has been employed previously for multiple pathologies, but there is no description of its use specifically for excision of dermal sinus tracts.  Here we present the technique of split laminotomy for excision of dermal sinus tract in four pediatric patients.

Methods:
A retrospective review of four cases of patients with dermal sinus tracts excised using split laminotomies, including the surgical video recordings.  The videos were edited to summarize the technique in key steps.  

Results:
Four patients underwent multilevel split laminotomy for complete excision of dermal sinus tracts.  The patients ranged from three to seven months. There were no surgical or postoperative complications.

Conclusion:  
Split laminotomy is an alternative to traditional laminectomy for multilevel posterior approach to the spinal canal that can preserve spinal integrity.  Split laminotomy for excision of dermal sinus tracts is a useful technique and our preliminary experience shows favorable results.