Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors

Object Spinal deformity in pediatric patients with intramedullary spinal cord tumors (IMSCTs) may be either due to neurogenic disability or due to secondary effects of spinal decompression. It is associated with functional decline and impairment in health-related quality-of-life measures. The authors sought to identify the long-term incidence of spinal deformity in individuals who had undergone surgery for IMSCTs as pediatric patients and the risk factors and overall outcomes in this population. Methods Treatment records for pediatric patients (age < 21 years) who underwent surgical treatment for histology-proven primary IMSCTs between 1975 and 2010 were reviewed. All patients were evaluated in consultation with the pediatric orthopedics service. Clinical records were reviewed for baseline and follow-up imaging studies, surgical fusion treatment, and long-term skeletal and disease outcomes. Results The authors identified 55 patients (30 males and 25 females) who were treated for pediatric IMSCTs between January 1975 and January 2010. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2–37.2 years). Preoperative skeletal deformity was diagnosed in 11 (20%) of the 55 patients, and new-onset postoperative deformity was noted in 9 (16%). Conservative management with observation or external bracing was sufficient in 8 (40%) of these 20 cases. Surgical fusion was necessary in 11 (55%). Posterior surgical fusion was sufficient in 6 (55%) of these 11 cases, while combined anterior and posterior fusion was undertaken in 5 (45%). Univariate and multivariate analysis of clinical and surgical treatment variables indicated that preoperative kyphoscoliosis (p = 0.0032) and laminectomy/laminoplasty at more than 4 levels (p = 0.05) were independently associated with development of spinal deformity that necessitated surgical fusion. Functional scores and 10-year disease survival outcomes were similar between the 2 groups. Conclusions Long-term follow-up is essential to monitor for delayed development of spinal deformity, and regular surveillance imaging is recommended for patients with underlying deformity. The authors' extended follow-up highlights the risk factors associated with development of spinal deformity in patients treated for pediatric IMSCTs. Surgical fusion allows patients who develop progressive deformity to achieve long-term functional and survival outcomes comparable to those of patients who do not develop progressive deformity.

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Risk factor analysis of progressive spinal deformity after resection of intramedullary spinal cord tumors in patients who underwent laminoplasty: a report of 105 consecutive cases

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18110 ◽

2019 ◽

Vol 30 (5) ◽

pp. 655-663 ◽

Cited By ~ 3

Author(s):

Wei Shi ◽

Shan Wang ◽

Huifang Zhang ◽

Guoqin Wang ◽

Yi Guo ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Logistic Regression ◽

Regression Analysis ◽

Spinal Deformity ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

OBJECTIVELaminoplasty has been used in recent years as an alternative approach to laminectomy for preventing spinal deformity after resection of intramedullary spinal cord tumors (IMSCTs). However, controversies exist with regard to its real role in maintaining postoperative spinal alignment. The purpose of this study was to examine the incidence of progressive spinal deformity in patients who underwent laminoplasty for resection of IMSCT and identify risk factors for progressive spinal deformity.METHODSData from IMSCT patients who had undergone laminoplasty at Beijing Tsinghua Changgung Hospital between January 2014 and December 2016 were retrospectively reviewed. Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative spinal deformity and radiographic, clinical, and surgical variables.RESULTSOne hundred five patients (mean age 37.0 ± 14.5 years) met the criteria for inclusion in the study. Gross-total resection (> 95%) was obtained in 79 cases (75.2%). Twenty-seven (25.7%) of the 105 patients were found to have spinal deformity preoperatively, and 10 (9.5%) new cases of postoperative progressive deformity were detected. The mean duration of follow-up was 27.6 months (SD 14.5 months, median 26.3 months, range 6.2–40.7 months). At last follow-up, the median functional scores of the patients who did develop progressive spinal deformity were worse than those of the patients who did not (modified McCormick Scale: 3 vs 2, and p = 0.04). In the univariate analysis, age (p = 0.01), preoperative spinal deformity (p < 0.01), extent of tumor involvement (p < 0.01), extent of abnormal tumor signal (p = 0.02), and extent of laminoplasty (p < 0.01) were identified as factors associated with postoperative progressive spinal deformity. However, in subsequent multivariate logistic regression analysis, only age ≤ 25 years and preoperative spinal deformity emerged as independent risk factors (p < 0.05), increasing the odds of postoperative progressive deformity by 4.1- and 12.4-fold, respectively (p < 0.05).CONCLUSIONSProgressive spinal deformity was identified in 25.7% patients who had undergone laminoplasty for IMSCT resection and was related to decreased functional status. Younger age (≤ 25 years) and preoperative spinal deformity increased the risk of postoperative progressive spinal deformity. The risk of postoperative deformity warrants serious reconsideration of providing concurrent fusion during IMSCT resection or close follow-up after laminoplasty.

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Instrumented fusion for spinal deformity after laminectomy or laminoplasty for resection of intramedullary spinal cord tumors in pediatric patients

Neurosurgical FOCUS ◽

10.3171/2017.7.focus17329 ◽

2017 ◽

Vol 43 (4) ◽

pp. E12 ◽

Cited By ~ 13

Author(s):

David S. Hersh ◽

Rajiv R. Iyer ◽

Tomas Garzon-Muvdi ◽

Ann Liu ◽

George I. Jallo ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Pediatric Patients ◽

Spinal Cord Tumor ◽

Similar Rate ◽

Single Institution ◽

Intramedullary Spinal Cord ◽

Current Series ◽

Surgical Fusion

OBJECTIVESpinal deformity has become a well-recognized complication of intramedullary spinal cord tumor (IMSCT) resection. In particular, laminectomy can result in biomechanical instability caused by loss of the posterior tension band. Therefore, laminoplasty has been proposed as an alternative to laminectomy. Here, the authors describe the largest current series of pediatric patients who have undergone laminoplasty for IMSCT resection and investigate the need for surgical fusion after both laminectomy and laminoplasty.METHODSThe medical records of pediatric patients who underwent resection of an IMSCT at a single institution between November 2003 and May 2014 were reviewed retrospectively. Demographic, clinical, radiological, surgical, histopathological, and follow-up data were collected.RESULTSSixty-six consecutive patients underwent resection of an IMSCT during the study period. Forty-three (65%) patients were male. The patients had a median age of 12.9 years (interquartile range [IQR] 7.2–16.5 years) at the time of surgery. Patients typically presented with a tumor that involved the cervical and/or thoracic spine. Nineteen (29%) patients underwent laminectomy, and 47 (71%) patients underwent laminoplasty. Patients in each cohort had a similar rate of postoperative deformity. Overall, 10 (15%) patients required instrumented spinal fusion for spinal deformity. Four patients required revision of the primary fusion.CONCLUSIONSThese findings show that among pediatric patients with an IMSCT, postoperative surgical fusion rates remain high, even after laminoplasty. Known risk factors, such as the age of the patient, location of the tumor, and the number of involved levels, might play a larger role than replacement of the laminae in determining the rate of surgical fusion after IMSCT resection.

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Long-term Follow-up of Intramedullary Spinal Cord Tumors: A Series of 202 Cases

Neurosurgery ◽

10.1227/01.neu.0000158318.66568.cc ◽

2005 ◽

Cited By ~ 1

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up

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Intramedullary Spinal Cord Tumors: Long-Term Follow-Up After Surgery

Tumors of the Central Nervous System - Tumors of the Central Nervous System, Volume 14 ◽

10.1007/978-94-017-7224-2_8 ◽

2015 ◽

pp. 79-93

Author(s):

Antonino Raco ◽

Marco Cimatti ◽

Massimo Miscusi

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up

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Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201084 ◽

2021 ◽

Vol 50 (5) ◽

pp. E21

Author(s):

Gil Kimchi ◽

Nachshon Knoller ◽

Akiva Korn ◽

Yahel Eyal-Mazuz ◽

Yechiam Sapir ◽

...

Keyword(s):

Spinal Cord ◽

Diagnostic Accuracy ◽

Postoperative Period ◽

Intraoperative Neuromonitoring ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Over Time ◽

D Wave

OBJECTIVE The use of intraoperative neuromonitoring (IONM) has become an imperative adjunct to the resection of intramedullary spinal cord tumors (IMSCTs). While the diagnostic utility of IONM during the immediate postoperative period has been previously studied, its long-term diagnostic accuracy has seldom been thoroughly assessed. The aim of this study was to evaluate long-term variations in the diagnostic accuracy of transcranial motor evoked potentials (tcMEPs), somatosensory evoked potentials (SSEPs), and D-wave recordings during IMSCT excision. METHODS The authors performed a retrospective evaluation of imaging studies, patient charts, operative reports, and IONM recordings of patients who were operated on for gross-total or subtotal resection of IMSCTs at a single institution between 2012 and 2018. Variations in the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for postoperative functional outcome (McCormick Scale) were analyzed at postoperative day 1 (POD1), 6 weeks postoperatively (PO-6 weeks), and at the latest follow-up. RESULTS Overall, 28 patients were included. The mean length of follow-up was 19 ± 23.4 months. Persistent motor attenuations occurred in 71.4% of the cohort. MEP was the most sensitive modality (78.6%, 87.5%, and 85.7% sensitivity at POD1, PO-6 weeks, and last follow-up, respectively). The specificity of the D-wave was the most consistent over time (100%, 83.35%, and 90% specificity at the aforementioned time points). The PPV of motor recordings decreased over time (58% vs 33% and 100% vs 0 for tcMEP and D-wave at POD1 and last follow-up, respectively), while their NPV consistently increased (67% vs 89% and 70% vs 100% for tcMEP and D-wave at POD1 and last follow-up, respectively). CONCLUSIONS The diagnostic accuracy of IONM in the resection of IMSCTs varies during the postoperative period. The decrease in the PPV of motor recordings over time suggests that this method is more predictive of short-term rather than long-term neurological deficits. The increasing NPV of motor recordings indicates a higher diagnostic accuracy in the identification of patients who preserve neurological function, albeit with an increased proportion of false-negative alarms for the immediate postoperative period. These variations should be considered in the surgical decision-making process when weighing the risk of resection-associated neurological injury against the implications of incomplete tumor resection.

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Correlation of a preoperative grading scale with progressive spinal deformity following surgery for intramedullary spinal cord tumors in children

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2008.2.10.277 ◽

2008 ◽

Vol 2 (4) ◽

pp. 277-281 ◽

Cited By ~ 8

Author(s):

Matthew J. McGirt ◽

Shlomi Constantini ◽

George I. Jallo

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Surgical Decision ◽

Scale Range ◽

Grade Ii ◽

Grading Scale ◽

Grade Iii

Object Postoperative progressive spinal deformity often complicates functional outcome after resection of pediatric intramedullary spinal cord tumors (IMSCTs). The authors propose a preoperative grading scale that correlates with the postoperative development of progressive spinal deformity requiring subsequent fusion. Methods The data obtained in 164 patients who underwent resection of an IMSCT at a single institution were retrospectively collected and analyzed to determine the development of progressive spinal deformity requiring fusion. A grading scale (range of scores I–V) was created based on the presence or absence of 4 preoperative variables: preoperative scoliosis, involvement of the thorocolumbar junction, age < 13 years, and number of surgeries for an IMSCT. The grading scale was then retrospectively applied to this series of 164 children to assess the correlation of variables with subsequent spinal deformity. Results Nine patients presented with Grade I status, 41 patients with Grade II, 58 patients with Grade III, 44 patients with Grade IV, and 12 patients with Grade V. Overall, 44 patients (27%) developed progressive spinal deformity requiring fusion at a mean follow-up of 5 years after surgery. A higher preoperative grade was associated with an increasing need for subsequent fusion for progressive spinal deformity (Grade I [0%], Grade II [5%], Grade III [26%], Grade IV [40%], and Grade V status [75%]). Conclusions Application of this grading scheme to a series of resected pediatric IMSCTs has demonstrated its correlation with the incidence of postoperative progressive spinal deformity requiring fusion. The application of a standardized grading scheme will assist in the process of surgical decision making and postoperative evaluation.

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Role of resection and adjuvant therapy in long-term disease outcomes for low-grade pediatric intramedullary spinal cord tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.5.peds15356 ◽

2016 ◽

Vol 18 (5) ◽

pp. 594-601 ◽

Cited By ~ 9

Author(s):

Raheel Ahmed ◽

Arnold H. Menezes ◽

James C. Torner

Keyword(s):

Adjuvant Therapy ◽

Pediatric Patients ◽

Functional Improvement ◽

Low Grade ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Disease Outcomes

OBJECTIVE Surgical excision is the mainstay treatment for resectable low-grade intramedullary spinal cord tumors (IMSCTs) in the pediatric age group. Chemotherapy and radiation treatments are generally reserved for progressive or recurrent disease. Given the indolent nature of low-grade tumors and the potential side effects of these approaches, their long-term treatment benefits are unclear. The aim of the study was to determine long-term disease outcomes and the therapeutic roles of surgery and adjuvant therapies in pediatric patients with low-grade IMSCTs over an extended follow-up period. METHODS Case records for all pediatric patients (< 21 years of age) with a histopathological diagnosis of low-grade IMSCT were selected over a period from January 1975 to January 2010. Outcome variables including McCormick functional grade, overall survival (OS), and progression-free survival (PFS) were analyzed with respect to demographic and treatment variables. RESULTS Case records of 37 patients with low-grade IMSCTs were identified, with a mean follow-up duration of 12.3 ± 1.4 years (range 0.5–37.2 years). Low-grade astrocytomas were the most prevalent histological subtype (n = 22, 59%). Gross-total resection (GTR) was achieved in 38% of patients (n = 14). Fusion surgery was required in 62% of patients with pre- or postoperative deformity (10 of 16). On presentation, functional improvement was observed in 87% and 46% of patients in McCormick Grades I and II, respectively, and in 100%, 100%, and 75% in Grades III, IV, and V, respectively. Kaplan-Meier PFS rates were 63% at 5 years, 57% at 10 years, and 44% at 20 years. OS rates were 92% at 5 years, 80% at 10 years, and 65% at 20 years. On multivariate analysis, shunt placement (hazard ratio [HR] 0.33, p = 0.01) correlated with disease progression. There was a trend toward improved 5-year PFS in patients who received adjuvant chemotherapy and radiation therapy (RT; 55%) compared with those who did not (36%). Patients who underwent subtotal resection (STR) were most likely to undergo adjuvant therapy (HR 7.86, p = 0.02). CONCLUSIONS This extended follow-up duration in patients with low-grade IMSCTs beyond the first decade indicates favorable long-term OS up to 65% at 20 years. GTR improved PFS and was well tolerated with sustained functional improvement in the majority of patients. Adjuvant chemotherapy and RT improved PFS in patients who underwent STR. These results emphasize the role of resection as the primary treatment approach, with adjuvant therapy reserved for patients at risk for disease progression and those with residual tumor burden.

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Thoracic intramedullary melanocytoma with long-term follow-up

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.9.08323 ◽

2008 ◽

Vol 9 (6) ◽

pp. 589-592 ◽

Cited By ~ 8

Author(s):

Geeta Chacko ◽

Vedantam Rajshekhar

Keyword(s):

Spinal Cord ◽

Differential Diagnosis ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up

Melanocytomas are tumors of the neuraxis seen predominantly in adults. The authors report a case of a thoracic intramedullary melanocytoma with long-term follow-up of 8 years postsurgery. Melanocytomas, although rare, must be included in the differential diagnosis of intramedullary spinal cord tumors.

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Risk factor analysis for progressive spinal deformity after resection of spinal cord tumors─a retrospective study of 272 cases

10.21203/rs.2.14477/v1 ◽

2019 ◽

Author(s):

Pangbo Wang ◽

Kang Ma ◽

Tunan Chen ◽

Xingsen Xue ◽

Dada Ma ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Spinal Deformity ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Spinal Cord Tumors

Abstract OBJECTIVE: Progressive spinal deformity has become a well-recognized complication of spinal cord tumors (SCTs)resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of SCTs. METHODS: We retrospectively analyzed the medical records of the patients with resection of SCTs between January 2009 and December 2018.All patients who underwent resection of spinal cord tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. RESULTS: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years)with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7（2.6%）patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6–114 months). In subsequent multivariate logistic regression analysis, age≤18 years(p=0.027), extent of tumor involvement(p = 0.019)and preoperative spinal deformity(p=0.008)was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94- , 0.69- and 27.11-fold, respectively. CONCLUSIONS: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons need to provide surgical fusion to reduce the risk of reoperation, neurologic compromise and patient’s medical burdens.

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