Preventing post-laminectomy spinal deformity in
children with intramedullary spinal cord tumors (Research
article)
This study was conducted with the goal of determining
if instrumented spinal fusion surgery performed at the time
of tumor removal is effective in preventing the development
of spinal deformity for children with intramedullary
spinal cord tumors.
Overall conclusions on spine surgery for spinal deformity
The study found that instrumented spinal fusion as
part of the same surgery to remove the tumor was usually
effective in preventing development of spinal deformity
(provided that there were no neurological deficits
caused by progression or recurrence of the tumor),
and therefore should be considered for all children
with intramedullary spinal cord tumors.
Process
This study was conducted at the Children’s
Hospital of Philadelphia. Since 1970, 129 children
with spinal cord tumors have been treated at the Children’s
Hospital of Philadelphia. Of these, 47 had intramedullary
tumors and were retrospectively reviewed: 15 of
the 47 patients were excluded from the study due to:
death within two years of diagnosis (8 patients); diagnosis
within the past two years (4 patients); or insufficient
follow-up to obtain the necessary information (3 patients).
The study reviewed the treatment results of 32 children
with a mean age at presentation of 9 years (ranging
from 2.5 to 14.9 years) and an average follow-up of
6.5 years (ranging from 2 to 22.7 years). An
average of 6.7 laminae per patient were removed (range
of 2 to 15) as part of the laminectomy procedure.
Results of spine surgery
Initial surgical treatment consisted of laminectomy
only (16 patients), laminoplasty (4 patients), and
laminectomy plus spinal fusion (12 patients).
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Of the 12 children who had spinal fusion surgery at
the time of tumor decompression, 5 developed significant
post-laminectomy deformity; however, four of these
five had progressive neurologic deficits due to progression
or recurrence of the tumor.
-
12 of the 20 children without spinal fusion surgery at
the time of tumor excision developed significant
spinal deformity: of those 12 who developed spinal
deformity, 5 had progressive neurologic deficits
due to tumor progression or recurrence.
Therefore, excluding those patients with progressive
neurologic deficits following tumor excision, only
1 of 8 children who had a spinal fusion developed a
deformity while 7 of 15 children without spinal fusion
developed a deformity.
By:
John Dormans, MD
May 5, 2004
Source: This article is based on poster number
P179, presented at the American Academy of Orthopedic
Surgeons 2004 annual meeting. The poster was
developed by Sumeet Garg, Brookline, MA, Scott S. Simon,
MD, Philadelphia, PA, Leslie N. Sutton, MD, Philadelphia,
PA, and John P. Dormans, MD, Philadelphia, PA.
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