Instability of the Spine Secondary to the Treatment of Intraspinal Tumors in Children: Diagnosis, Cure, and Prevention

Dubousset, Jean

doi:10.1007/978-1-4613-9326-9_10

Cited by 2 publications

(3 citation statements)

References 2 publications

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“…Therefore, we recommend that all children treated with laminectomy be provided with a proper external support from the first postoperative day. Simultaneous laminectomy and posterolateral fusion (without internal fixation) are recommended by some authors [1,3,8,14,15], but it is also mandatory to have a postoperative external immobilisation of the spine in a correct posture [6,8]. Laminoplasty may also be a solution if the tumour does not involve the posterior vertebral elements, but a necessary condition for success is the adequate fixation of the replaced block of laminae with intraosseous sutures and immobilisation of the spine with a cast or halo cast in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…In hyperrotatory paradoxic kyphosis [4,7], the approach for anterior release is on the convex side of the scoliosis. There is no strut grafting, but anterior fusion with the use of either bone chips or rib-inlay grafting is performed [6].…”

Section: Discussionmentioning

confidence: 99%

“…If a deficit appears or deteriorates, this can stem either from the recurrence of a spinal tumour, or from the anterior bony compression of the cord at the level of the apex of the kyphosis. In addition, a paralytic deformity may develop at a distance from the initial neurological lesion [6]. This can result in further deterioration of spinal stability, which is already affected by the deformity at the level of the laminectomy.…”

Section: Introductionmentioning

confidence: 99%

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Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours

Slullitel²,

et al. 2005

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This is a retrospective study of 76 children who had had malignant tumours treated with laminectomy or laminoplasty and/or radiation therapy affecting the spine. Spinal tumours in children are extremely rare. However, their treatment can result in progressive spinal deformity. Radiation therapy affecting the growing spine can lead to asymmetric vertebral growth, causing kyphosis and/or scoliosis. These spinal deformities pose one of the most challenging problems for the spine surgeon. The aim of this article is to describe late-onset post-laminectomy/post-radiation spinal deformities and to evaluate the results of their treatment. Seventy-six children, with a mean age of 4 years and 7 months (range, 2 months to 16 years), underwent surgical removal of malignant tumours, between 1961 and 1995. Sixty-seven of them developed post-laminectomy/post-radiation spinal deformity. Conservative treatment consisted of bracing and corrective plaster casts. In 46 cases the deformity was treated surgically. A distraction plaster cast was used as preoperative preparation in the more severe and rigid curves, with or without neurological impairment. Surgery consisted of combined anterior and posterior fusion in 39 cases and posterior fusion in seven cases. Posterior instrumentation was used in 38 cases. The mean follow-up period was 6 years and 7 months (range, 9 months to 20 years and 2 months). Nine children did not develop deformity following the primary tumour treatment. One of them underwent laminectomy with posterolateral fusion and eight had laminoplasty combined with external immobilisation. Forty-six children developed iatrogenic kyphosis and underwent surgical correction from a mean of 75 degrees pre-correction to a mean of 32 degrees . The mean scoliotic angle correction was 66 degrees preoperatively to 34 degrees postoperatively. At follow-up, the mean correction loss was 7 degrees in the sagittal plane and 5 degrees in the coronal plane. Preoperative distraction plaster cast treatment resulted in a correction of 39% in kyphosis and of 58% in scoliosis, and in a partial or complete recovery of neurological deficits in all but one patient. In severe and rigid curves that develop following treatment of paediatric spinal tumours, preoperative application of a distraction plaster cast can reduce deformity and facilitate surgical correction. Furthermore, in the case of pure bony compression of the spinal cord due to the apical vertebra of the deformity, treatment with the distraction plaster can result in recovery from the neurological impairment. The prevention of post-laminectomy/post-radiation spine deformities is emphasised. Rigid external immobilisation for a period of 4 months in the cervical spine and of 6 months in the thoracic spine is recommended after both laminoplasty and laminectomy with posterolateral fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours

Slullitel²,

et al. 2005

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Proximal Junctional Kyphosis in Modern Spine Surgery: Why Is it So Common?

Dubousset

Diebo

2023

Spine Surg Relat Res

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In the past few decades, proximal junctional kyphosis (PJK) has emerged as a new complication after instrumented spinal fusion in adult and pediatric spinal deformities. This phenomenon has occurred concomitantly with the rise of robust instrumentation techniques and enhancement of our abilities to obtain greater spinal deformity correction. The goal of this paper is to review the mechanical and biological causes of PJK and recommend prevention strategies.

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Instability of the Spine Secondary to the Treatment of Intraspinal Tumors in Children: Diagnosis, Cure, and Prevention

Cited by 2 publications

References 2 publications

Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours

Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours

Proximal Junctional Kyphosis in Modern Spine Surgery: Why Is it So Common?

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