Introduction: Treatment of pediatric intramedullary spinal cord tumors (IMSCT) is associated with risk of secondary spinal deformity. There is a lack of consensus for optimal management of spinal deformity. We present our institutional experience in the management of spinal deformity in pediatric IMSCTs, analyzing the risks factors and the respective roles of conservative and surgical fixation.
Methods: Case records for pediatric patients (<21yr), treated at our institution for IMSCTs were analyzed.
Results: Fifty five patients (male=30, female=25), mean age of 10yr (range: 0.5mo–20yr) were identified from 1975 to 2010. Mean follow up period was 9.5yr (6mo - 36yr). Low-grade astrocytomas (n=24; 44%) were most prevalent followed by ependymomas (n=11, 20%), ganglogliomas (n=5, 9%) and anaplastic astrocytomas (n=7, 13%). Overall incidence of patients with significant spinal deformity was 27% (n=15). Of these, 6/15 (40%) had preexisting de novo or secondary (as a result of preceding surgery) deformity. Incidence of spinal fusion for patients with significant kyphosis/scoliosis was 60% (n=9/15), with an overall incidence of spinal fusion at 16% for our study population (n=9/55). Spinal orthosis was sufficient for management in 40% of patients with spinal deformity (n=6/15). Age <11yr (p-value <0.01), number of laminectomy levels (>4 levels; p value <0.01), poor functional grade (McCormick scale IV-V) and preexisting deformity at presentation co related with development/progression of significant spinal deformity. Osteoplastic laminoplasty appeared to reduce the risk of spinal deformity development.
Conclusions: The development of spinal deformity in pediatric IMSCT patients is associated with high incidence of spinal fusion. Identification of risk factors enables detection and close monitoring of patients at risk for developing functional deterioration secondary to progressive deformity. Routine use of prophylactic fusion is not warranted. Osteoplastic laminoplasty may augment spinal stability and aid in averting spinal deformity.
Patient Care: Elucidation of treatment algorithms will enable identification and clinical management of secondary spinal deformity development following resection of intramedullary tumors in pediatric patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the risk factors associated with development of spinal deformity in pediatric patients with intramedullary tumors; (2) Describe the management options for post operative spinal deformity.