Spinal deformity and pediatric intramedullary spinal cord tumors

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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Laminoplasty Versus Laminectomy Is Associated with a Decreased Incidence of Spinal Deformity after Resection of Intramedullary Spinal Cord Tumors in Children

Neurosurgery ◽

10.1227/01.neu.0000279929.72999.8e ◽

2007 ◽

Vol 61 (1) ◽

pp. 211-211 ◽

Cited By ~ 1

Author(s):

Matthew McGirt ◽

Kevin C. Yao ◽

Timothy F. Witham ◽

Ali Bydon ◽

Kaisorn L. Chaichana ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(09)79243-9 ◽

2009 ◽

Vol 2009 ◽

pp. 263-266

Author(s):

P. Klimo

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Spinal deformity after resection of cervical intramedullary spinal cord tumors in children

Child s Nervous System ◽

10.1007/s00381-007-0513-4 ◽

2007 ◽

Vol 24 (6) ◽

pp. 735-739 ◽

Cited By ~ 12

Author(s):

Matthew J. McGirt ◽

Kaisorn L. Chaichana ◽

Frank Attenello ◽

Timothy Witham ◽

Ali Bydon ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.1.peds13317 ◽

2014 ◽

Vol 13 (6) ◽

pp. 613-621 ◽

Cited By ~ 33

Author(s):

Raheel Ahmed ◽

Arnold H. Menezes ◽

Olatilewa O. Awe ◽

Kelly B. Mahaney ◽

James C. Torner ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Deformity ◽

Pediatric Patients ◽

Survival Outcomes ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Surgical Fusion

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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