Surgical Treatment of Spinal Deformities in Young Paraplegic Children with Intraspinal Tumors

Abstract

Bilateral vertical expandable prosthetic titanium rib (VEPTR) treatment using rib-to-pelvis constructs without touching the spine is a safe surgical technique to correct scoliosis while still allowing further MRI or neurosurgical interventions. In this retrospective cohort study, 4 paraplegic children with spinal deformity after intraspinal tumors and 4 children with neuromuscular diseases were compared. VEPTR treatment was able to considerably reduce the main scoliotic curve in both patient groups (41 vs. 40%). However, the tumor group constantly showed more severe curve progression over time and less favorable pelvic obliquity control. In conclusion, bilateral VEPTR can be expected to be less satisfying in children with tumors.

Spinal Deformities after Childhood Tumors

“…In our study, nine skeletally immature patients received VEPTR treatment with an average deformity correction of 41% after initial implantation, which lies within the range of 29-41% correction as reported in other studies [11,12,27]. A small group of paraplegic children with intraspinal tumors who were treated with bilateral growth-friendly spinal implants had been previously analyzed and compared to neuromuscular patients by our study group [11]. Even though these patient numbers are small, a significant initial curve correction constantly showed more severe curve progression over time in the tumor group and less favorable pelvic obliquity control [11].…”

“…Bilateral rib-to-pelvis VEPTR constructs have the advantage of leaving the spine untouched as well as being expanded without the use of magnetic components, thus allowing MRI examinations after device implantation [10]. In our study, nine skeletally immature patients received VEPTR treatment with an average deformity correction of 41% after initial implantation, which lies within the range of 29-41% correction as reported in other studies [11,12,27]. A small group of paraplegic children with intraspinal tumors who were treated with bilateral growth-friendly spinal implants had been previously analyzed and compared to neuromuscular patients by our study group [11].…”

“…A small group of paraplegic children with intraspinal tumors who were treated with bilateral growth-friendly spinal implants had been previously analyzed and compared to neuromuscular patients by our study group [11]. Even though these patient numbers are small, a significant initial curve correction constantly showed more severe curve progression over time in the tumor group and less favorable pelvic obliquity control [11].…”

“…The surgical treatment consisted either of an implantation of growth-friendly spinal devices with repetitive lengthening procedures in children younger than ten years of age so as to allow spinal and thoracic growth or a definite spinal fusion during puberty, with or without prior halo traction, to stretch and straighten the spine and to reduce neurological risks. Growth-friendly spinal implants such as bilateral vertical expandable prosthetic titanium ribs (VEPTR) were implanted with a rib-to-pelvis fixation [8][9][10][11][12]. This spinal non-touch technique still allowed MRI assessment of spinal tumors and neurosurgical intervention if needed.…”

“…Furthermore, the neurosurgical approach needs to be preserved for eventual secondary CNS tumor surgery in the future. Using growth-friendly spinal implants such as the vertical expandable prosthetic titanium rib (VEPTR), devices parallel to the spine with a rib-to-pelvis fixation [8][9][10][11][12] respect such needs, allowing access to the spinal canal and MRI. Long-term results of this technique on young paraplegic children with intraspinal tumors, although less favorable in comparison to its application on neuromuscular scoliosis due to spinal muscular atrophy, have been described by Lorenz et al [11].…”