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).

• 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.

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.