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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Gross-total resection of pediatric intramedullary spinal cord tumor (IMSCT) can be achieved in the majority of cases while preserving long-term neurological function. Nevertheless, postoperative progressive spinal deformity often complicates functional outcome years after surgery. The authors set out to determine whether laminoplasty in comparison with laminectomy has reduced the incidence of subsequent spinal deformity requiring fusion after IMSCT resection at their institution.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The first 144 consecutive patients undergoing resection of IMSCTs at a single institution underwent laminectomy with preservation of facet joints. The next 20 consecutive patients presenting for resection of IMSCTs underwent osteoplastic laminotomy regardless of patient or tumor characteristics. All patients were followed up with telephone interviews corroborated by medical records for the following outcomes: 1) neurological and functional status (modified McCormick Scale [MMS] score and Karnofsky Performance Scale [KPS] score); and 2) development of progressive spinal deformity requiring fusion. The incidence of progressive spinal deformity and the long-term neurological function were compared between the laminectomy and osteoplastic laminotomy cohorts. The means are expressed ± the standard deviation.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall, the patients' mean age was 8.6 ± 5 years, and they presented with median MMS scores of 2 (interquartile range [IQR] 2–4). A &gt; 95% resection was achieved in 125 cases (76%). There were no differences (p &gt; 0.10) between patients treated with osteoplastic laminotomy and those treated with laminectomy in terms of the following characteristics: age; sex; duration of symptoms; location of tumor; incidence of preoperative scoliosis (Cobb angle &gt; 10°: 7 [35%] with laminoplasty compared with 49 [34%] with laminectomy); involvement of the cervicothoracic junction (7 [35%] compared with 57 [40%]); thoracolumbar junction (4 [20%] compared with 36 [25%]); tumor size; extent of resection; radiation therapy; histopathological findings; or mean operative spinal levels (7.5 ± 2 compared with 7.5 ± 3). Nevertheless, patients who underwent osteoplastic laminotomy had better median preoperative MMS scores than those treated with laminectomy (2 [IQR 2–2] compared with 2 [IQR 2–4]; p = 0.04). A median of 3.5 years (IQR 1–7 years) after surgery, only 1 patient (5%) in the osteoplastic laminotomy cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (p = 0.027). Adjusting for the inter-cohort difference in preoperative MMS scores, osteoplastic laminotomy was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, 95% confidence interval 0.02–1.00; p = 0.05). The median MMS and KPS scores were similar between patients who underwent osteoplastic laminotomy and those in whom laminectomy was performed (MMS Score 2 [IQR 2–3] for laminotomy compared with 2 [IQR 2–4] for laminectomy, p = 0.54; KPS Score 90 [IQR 70–100] for laminotomy compared with 90 [IQR 80–90] for laminectomy, p = 0.545) at a median of 3.5 years after surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In the authors' experience, osteoplastic laminotomy for the resection of IMSCT in children was associated with a decreased incidence of progressive spinal deformity requiring fusion but did not affect long-term functional outcome. Laminoplasty used for pediatric IMSCT resection may decrease the incidence of progressive spinal deformity requiring subsequent spinal stabilization in some patients.</jats:p></jats:sec>

Infantile Cervical Intramedullary Cavernous Angioma Manifesting as Hematomyelia -Case Report-

“…11) In addition to the growth of spine, these features accentuate the alteration of spinal biomechanics caused by tumor resection with consequent spinal deformity. 11,34,44) The length and extent of laminectomy, which leads to loss of posterior supporting elements, are directly associated with increased risk of postoperative deformity, 18,23,28,46) although other factors such as age, tumor location, preoperative spinal deformity, extent of facet resection, and degree of tumor resection also influence the occurrence of postoperative spinal deformity. 30,44) In consideration of the hypothesis above, osteoplastic laminotomy, which enables replacement of the original bony structure, may be associated with less spinal deformity.…”

“…30) Decreased incidence of progressive spinal deformity requiring fusion was demonstrated following osteoplastic laminotomy for the resection of intramedullary spinal cord tumors in children. 23) Our patient was 3 months old when the surgery was performed. CT showed synchondroses at the center of each lamina which usually unites in the second or third year.…”

“…30,44) In consideration of the hypothesis above, osteoplastic laminotomy, which enables replacement of the original bony structure, may be associated with less spinal deformity. 7,16,23,29) These techniques are recommended to preserve the anatomical planes and facilitate subsequent exposure, including spinal fusion when needed, 24,25) although whether replacement laminoplasty or osteoplastic laminotomy techniques can prevent postoperative spinal deformity remains to be proven. 30) Decreased incidence of progressive spinal deformity requiring fusion was demonstrated following osteoplastic laminotomy for the resection of intramedullary spinal cord tumors in children.…”

Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality

“…1 It has been showed that the laminoplasty when compared with the laminectomy decreases the postoperative spinal deformity for treatment of intradural lesions, especially at the thoracolumbar junction, in pediatric cases. 4 In the presented case we preferred to perform laminectomy and extensive duraplasty to ensure the effective decompression of the spinal cord. In the presented case rapid neurologic improvement was achieved immediately after operation and postoperative MRI showed no spinal deformity.…”

Management of cervical spine deformity after intradural tumor resection

“…Whenever possible, a laminoplasty is preferred over a laminectomy as long as the tumor resection would not be compromised, because laminoplasty makes the revision operation substantially easier and safer. 24,27,31 If a laminectomy is necessary, one can replace the lamina and hold it in place with the miniplates used by hand surgeons. If that is not possible, closing the first layer of the soft tissues with a running, nonabsorbable, colored suture and closing the subsequent layer with an absorbable or noncolored suture will enable the surgeon to identify the last layer before the dura in the revision operation.…”