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Lu VM, Jallo GI, Shimony N. Intramedullary pediatric low-grade glioma of the spine. Childs Nerv Syst 2024:10.1007/s00381-024-06499-1. [PMID: 38904769 DOI: 10.1007/s00381-024-06499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Pediatric intramedullary spinal cord low-grade gliomas (pLGGs) are rare diagnoses among central nervous system (CNS) tumors in the pediatric population. The classic presentation of the patients includes some degree of neurologic deficit, although many times the symptoms are vague which leads to delayed diagnosis. MATERIAL AND METHODS The first step in the diagnosis includes special parameters in spinal imaging, particularly magnetic resonance imaging (MRI), and surgical resection remains the cornerstone for both diagnosis and treatment. Yet, recent years advancement in molecular and genetic understanding of CNS tumors allows for better adjustment of the treatment and follow-up regimens. Based on postoperative status, adjuvant therapy may provide additional therapeutic advantage for some types of tumors. CONCLUSION Ultimately, patients have a very promising prognosis when treated appropriately in most of the cases of pediatric spinal cord LGG with continued advances arising. This manuscript summarizes the most contemporary evidence regarding clinical and treatment features of intramedullary pLGGs.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - George I Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
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Jiang Q, Gao H, Gao G, Li Y, Cheng H, Shi G, Shang A. Neuroblastoma of the lumbosacral canal in an adult: a case report and literature review. Front Neurol 2023; 14:1195664. [PMID: 37602246 PMCID: PMC10435846 DOI: 10.3389/fneur.2023.1195664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Neuroblastoma (NB) is a leading cause of death in children. It usually occurs in the adrenal gland and rarely in the spinal canal. Here, we report the case of a 48-year-old male patient with abnormal thickening of the cauda equina nerve as revealed by lumbosacral magnetic resonance imaging. The patient's main clinical manifestations were numbness and pain in both lower limbs. The patient underwent surgical treatment; however, intraoperatively, an unclear border was observed between the cauda equina nerve and the tumor; therefore, the tumor was not forcibly excised. The postoperative pathological results were reported as NB. The disease known as NB, which is extremely rare. We believe that a pathological biopsy is extremely vital for diagnosing NB, and aggressive post-operative radio-chemotherapy could potentially prolong the patient's survival time.
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Affiliation(s)
| | - Haihao Gao
- Chinese PLA Medical School, Beijing, China
| | - Gan Gao
- Chinese PLA Medical School, Beijing, China
| | - Yang Li
- Department of Critical Care Medicine, Chinese PAP Beijing Corps Hospital, Beijing, China
| | | | | | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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Rogers N, Selberg C, LaMotta C, Beebe C, Bloch N, Erickson M, Donaldson NJ. Treatment of Kyphosis Arising Secondary to Laminectomy and Irradiation in the Pediatric Population. Orthopedics 2021; 44:e563-e569. [PMID: 34292816 DOI: 10.3928/01477447-20210618-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effects of radiation therapy and laminectomy on the growing spine have been well documented. Due to compromised bone quality after irradiation, spinal fusion has a high failure rate. The aim of this study was to evaluate treatment of post-laminectomy and post-irradiation kyphosis in children using a vascularized rib graft (VRG) to augment anterior spinal fusion and posterior spinal fusion. Data were collected retrospectively from electronic medical records for all patients treated at a single institution for post-laminectomy and post-irradiation kyphosis who underwent VRG to augment spinal fusions done between December 2003 and August 2015. Five patients were included in the analysis. Imaging studies were analyzed by 2 senior pediatric orthopedic surgeons and a pediatric orthopedic surgery fellow. The outcome for all 5 patients who underwent VRG were considered successful at most recent clinical follow-up. Success was defined as the following: complete fusion evident through computed tomography scan, no implant failure, and no kyphosis progression. Follow-up ranged from 21 to 63 months. One patient experienced 2 complications: esophageal tear and deep infection. Spinal fusion with a VRG is a viable treatment option for children who have developed kyphosis following laminectomy and irradiation. On long-term follow-up, there has been no evidence of progression of kyphosis for patients who were treated with VRG in either the primary fusion procedure or in subsequent revision procedures. A VRG provides a non-irradiated, vascularized bone graft to bridge the irradiated segments, increasing the stability of the spine. [Orthopedics. 2021;44(4):e563-e569.].
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Bourghli A, Boissiere L, Obeid I. T12 pedicle subtraction osteotomy for post-laminectomy kyphoscoliotic deformity following resection of a thoracolumbar astrocytoma in an adolescent with a previous paraplegic context. Spine Deform 2021; 9:275-283. [PMID: 32965627 DOI: 10.1007/s43390-020-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Case report. PURPOSE To describe a rare case of iatrogenic post-laminectomy thoracolumbar kyphoscoliosis in an adolescent, and its surgical management with pedicle subtraction osteotomy (PSO). BACKGROUND Kyphoscoliosis secondary to multilevel laminectomies for intradural astrocytoma resection is rare and its management can be very challenging. METHODS We report the case of 15-year-old boy who has been complaining of a progressively increasing hump in his back during the past 6 months. Two years prior to presentation, he underwent multilevel thoracolumbar laminectomies from T10 to L2 for resection of an intradural astrocytoma that was causing progressive paraplegia predominant on the right side. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 73° between T10 and L1, with a long left thoracolumbar scoliosis of 24 degrees. CT scan confirmed the multilevel laminectomies and showed T12 anterior wedging. MRI did not show any tumor recurrence. RESULTS The patient underwent T12 PSO with instrumentation from T4 to L3 with the use of a one-sided domino on the convex side. Thoracolumbar kyphosis was corrected to 9°, and scoliosis was corrected to 7°, with a maintained correction at 7 years of follow-up. CONCLUSION Literature is sparse on the management of post-laminectomy kyphoscoliotic deformity after intradural astrocytoma resection. Despite previous paraplegia context, aggressive correction technique such as PSO can be a safe option if proper management of the scar tissues and adhesions is performed, with satisfactory clinical and radiological long-term results.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Srivastava S, Marathe N, Bhosale S, Gautham S. Correction of Postlaminectomy Cervical Kyphosis in an Operated Case of Cervical Spine Primitive Neuroectodermal Tumor. Asian J Neurosurg 2019; 14:1017-1020. [PMID: 31497156 PMCID: PMC6703015 DOI: 10.4103/ajns.ajns_52_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 14-year-old boy presented with gradually worsening spastic quadriparesis and cervical kyphotic deformity as a consequence of laminectomy for tumor debulking and chemoradiotherapy done 2 years prior for cervical primitive neuroectodermal tumor. Problems to be addressed particularly to the case were a rigid kyphosis of 102.7°, poor soft-tissue coverage, internal gibbus compressing cord, perched facets, and superficial location of cord. The surgery was staged, in that the first anterior release was done with gradually increasing traction to correct the kyphosis progressively. Posterior instrumentation was done in the second stage. Finally, anterior reconstruction with tricortical iliac bone grafting was done. The patient regained full power with complete union at the end of 18 months. Irradiation of tumor along with laminectomy results in loss of posterior tension band which results in progressive kyphotic deformity in children. A staged plan of surgical interventions can help in postoperative correction of deformity with circumferential union and prevention of recurrence. This article describes successful treatment of a patient with postlaminectomy cervical kyphosis with 77° of correction achieved postoperatively and also highlights the importance of anterior and posterior reconstructions to achieve a stable vertebral column.
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Affiliation(s)
- Sudhir Srivastava
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nandan Marathe
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Bhosale
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sai Gautham
- Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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One-Stage Wedge Osteotomy Through Posterolateral Approach for Cervical Postlaminectomy Kyphosis with Anterior Fusion. World Neurosurg 2018; 119:45-51. [PMID: 30064029 DOI: 10.1016/j.wneu.2018.07.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Osteotomy through anterior exposure is challenging with severe complications for upper cervical kyphosis (CK), especially for cases with previous anterior fusion. A novel technique comprising 1-stage osteotomy via a posterolateral-only approach is introduced for treatment of CK secondary to C2-4 laminectomy for neurofibroma removal and subsequent anterior fusion. METHODS A 42-year-old man presented with progressive numbness and weakness of upper and lower limbs. As an adolescent, he underwent posterior laminectomy and neurofibroma excision without effective fixation and anterior C2-4 vertebra fusion 6 years later. Sagittal computed tomography indicated that Cobb angle between C2 and C6 was 68° with complete fusion between C2 and C4 vertebral bodies. Secondary CK was diagnosed based on medical history and radiographic findings, and modified Japanese Orthopaedic Association scale score was 10. Piezosurgery was used for osteotomy by shortening the vertebral height through posterolateral approach after cervical pedicle screw placement. Occipitocervical fusion was performed with compression between C2 and C4. RESULTS Cobb angle was adjusted to 8° postoperatively. Modified Japanese Orthopaedic Association score increased to 14 with obvious muscle strength improvement. The 6-month postoperative x-ray indicated good position of C2-4 vertebrae and occipitocervical fixation system. No neurologic complications or local recurrence was found at final follow-up at 8 months. The patient returned to work in his full capacity. CONCLUSIONS Preliminary outcomes reveal wedge osteotomy via piezosurgery through a posterolateral-only approach is feasible and effective in revision surgery for upper CK with previous anterior fusion.
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Treatment of Spinal Tumors in a High Volume Center has Direct Impact on Local Recurrence, Morbidity, and Mortality. Clin Spine Surg 2017; 30:E1074-E1081. [PMID: 28719452 DOI: 10.1097/bsd.0000000000000482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE OF THE STUDY En bloc resections of spine tumors aim at locally controlling the disease for both improving the patient's quality of life as well as improving mortality. The purpose of this study was to compare the outcome between patients who were initially treated in a high volume specialized center, and patients who initially underwent either invasive diagnostic procedure or an initial surgical attempt to treat the disease in a different center. MATERIALS AND METHODS A retrospective study of 1681 patients affected by spine tumors-treated from 1990 to 2015 by the same team. RESULTS A total of 220 en bloc resections that were performed on 216 patients during that period. Most of the tumors were primary-165 cases (43 benign and 122 malignant), metastases occurred in 55 cases. One hundred sixty-eight patients (77.8%) were solely treated in the institute and were considered noncontaminated cases (NCCs) and 48 (22.2%) were previously treated elsewhere and were considered contaminated cases (CCs). Median follow-up was 45 months (0-371).Thirty-three local recurrences (15.28%) were recorded. Fourteen patients (29.17%) from the CC and 19 (11.31%) from the NCC group.A total of 153 complications were observed in 100 out of 216 patients (46.2%). Sixty-four of these patients (30%) suffered 1 complication, while the rest had 2 or more. Twenty-eight (58%) of the CC group and 72 (42.85%) of the NCC group, had at least 1 complication.Sixty patients died as a result of the disease during the follow-up period. Twenty-one (43.75%) and 39 (23.21%) patients died in the CC and NCC cohorts, respectively.CC, surgical margins of the resected tumor-intralesional, marginal, and malignant tumors, were statistically significant independent risk factors for local recurrence of the tumor. Contamination, local recurrence, neoadjuvant radiotherapy, the number of level resected, and metastatic tumors compared with primary malignant tumor, were shown to be independent risk factors for patient's death. CONCLUSIONS It is apparent that there is a substantial added risk in performing either invasive diagnostic procedures or attempting a surgical resection of the tumor in a nonspecialized center. This risk includes both higher recurrences of the tumor as well as increased mortality. It is therefore reasonable to conclude that the whole treatment, from biopsy to resection, should be performed in the same center, and this center should be a high volume, specialized in treating these type of spine pathologies.The surgeon who treats the patient first has a great responsibility, as it is the first treatment that most affects prognosis. To reduce the chance of local recurrence, morbidity, and mortality, all invasive diagnosis and treatment, should be performed by an experienced team, as the consequences are dramatic.
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Trahair T, Sorrentino S, Russell SJ, Sampaio H, Selek L, Plantaz D, Freycon C, Simon T, Kraal K, Beck-Popovic M, Haupt R, Ash S, De Bernardi B. Spinal Canal Involvement in Neuroblastoma. J Pediatr 2017. [PMID: 28645442 DOI: 10.1016/j.jpeds.2017.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia; School of Women's & Children's Health, University of New South Wales Medicine, Randwick, Australia.
| | - Stefania Sorrentino
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Susan J Russell
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Laurent Selek
- Neurosurgery Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Dominique Plantaz
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Claire Freycon
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Thorsten Simon
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Kathelijne Kraal
- Department Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Maja Beck-Popovic
- Department of Pediatrics, Hematology-Oncology Unit, University Hospital, Lausanne, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Shifra Ash
- The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Bruno De Bernardi
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Surgeon’s perception of margins in spinal en bloc resection surgeries: how reliable is it? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:868-873. [DOI: 10.1007/s00586-017-4967-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
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Ahmed R, Menezes AH, Torner JC. Role of resection and adjuvant therapy in long-term disease outcomes for low-grade pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr 2016; 18:594-601. [PMID: 27420482 DOI: 10.3171/2016.5.peds15356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Surgical excision is the mainstay treatment for resectable low-grade intramedullary spinal cord tumors (IMSCTs) in the pediatric age group. Chemotherapy and radiation treatments are generally reserved for progressive or recurrent disease. Given the indolent nature of low-grade tumors and the potential side effects of these approaches, their long-term treatment benefits are unclear. The aim of the study was to determine long-term disease outcomes and the therapeutic roles of surgery and adjuvant therapies in pediatric patients with low-grade IMSCTs over an extended follow-up period. METHODS Case records for all pediatric patients (< 21 years of age) with a histopathological diagnosis of low-grade IMSCT were selected over a period from January 1975 to January 2010. Outcome variables including McCormick functional grade, overall survival (OS), and progression-free survival (PFS) were analyzed with respect to demographic and treatment variables. RESULTS Case records of 37 patients with low-grade IMSCTs were identified, with a mean follow-up duration of 12.3 ± 1.4 years (range 0.5-37.2 years). Low-grade astrocytomas were the most prevalent histological subtype (n = 22, 59%). Gross-total resection (GTR) was achieved in 38% of patients (n = 14). Fusion surgery was required in 62% of patients with pre- or postoperative deformity (10 of 16). On presentation, functional improvement was observed in 87% and 46% of patients in McCormick Grades I and II, respectively, and in 100%, 100%, and 75% in Grades III, IV, and V, respectively. Kaplan-Meier PFS rates were 63% at 5 years, 57% at 10 years, and 44% at 20 years. OS rates were 92% at 5 years, 80% at 10 years, and 65% at 20 years. On multivariate analysis, shunt placement (hazard ratio [HR] 0.33, p = 0.01) correlated with disease progression. There was a trend toward improved 5-year PFS in patients who received adjuvant chemotherapy and radiation therapy (RT; 55%) compared with those who did not (36%). Patients who underwent subtotal resection (STR) were most likely to undergo adjuvant therapy (HR 7.86, p = 0.02). CONCLUSIONS This extended follow-up duration in patients with low-grade IMSCTs beyond the first decade indicates favorable long-term OS up to 65% at 20 years. GTR improved PFS and was well tolerated with sustained functional improvement in the majority of patients. Adjuvant chemotherapy and RT improved PFS in patients who underwent STR. These results emphasize the role of resection as the primary treatment approach, with adjuvant therapy reserved for patients at risk for disease progression and those with residual tumor burden.
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Affiliation(s)
- Raheel Ahmed
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada; and
| | | | - James C Torner
- Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R. En Bloc Resections in the Spine: The Experience of 220 Patients During 25 Years. World Neurosurg 2016; 98:217-229. [PMID: 27794510 DOI: 10.1016/j.wneu.2016.10.086] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE En bloc resections aim at surgically removing a tumor in a single, intact piece. Approach must be planned for the complete removal of the tumor without violation of its margins. The shared knowledge of the morbidity, mortality, risk assessment for local disease recurrence, complications, and death, related to spine tumors excised en bloc could improve the treating physician's apprehension of the diseases and decision making process before, during, and after surgical treatment. The purpose of this study was to review and report the experience gained during 25 years in one of the world's biggest spine oncologic centers. METHODS A retrospective study of prospective collected data of 1681 patients affected by spine tumors, of whom 220 had en bloc resections performed. RESULTS Most tumors were primary-165 cases (43 benign and 122 malignant); metastases occurred in 55 patients. A total of 60 patients died from the disease and 33 local recurrences were recorded. A total of 153 complications were observed in 100 of 216 patients (46.2%); 64 of these patients (30%) suffered 1 complication, whereas the rest had 2 or more. All complications were categorized according to temporal distribution and severity. These were further divided into 7 groups according to the type of complication. There were 105 major and 48 minor complications. Seven patients (4.6%) died as a result of complications. There were 33 local recurrences (15.28%) recorded. Contaminated cases, surgical margins of the resected tumor-intralesional, marginal, and malignant tumors-were statistically significant independent risk factors for local recurrence of the tumor. Contamination, local recurrence, neoadjuvant radiotherapy, number of levels resected, and metastatic tumors compared with primary malignant tumor were shown to be independent risk factors for a patient's death. CONCLUSIONS Treatment of spinal aggressive benign and malignant bone tumors with en bloc resection is beneficial in terms of better local control and prognosis, although it is a highly demanding and risky procedure. Margins are the key point of this procedure, thus a careful preoperative oncologic and surgical staging is necessary to define the optimal surgical approach. The adverse event profile of these surgeries is high. Therefore, it should be performed by experienced and multidisciplinary teams in specialized high volume centers.
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Affiliation(s)
- Stefano Boriani
- Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, Unit of Oncologic Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Ran Lador
- Unit of Spine Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel.
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Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R. Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3932-3941. [PMID: 26972427 DOI: 10.1007/s00586-016-4463-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/06/2016] [Accepted: 02/07/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Identify risk factors, enabling reduction of the rate of complications and improve outcome in en bloc resection surgeries. METHODS A retrospective study of prospective collected data of 1681 patients affected by spine tumors treated from 1990 to 2015 by the same team. RESULTS A total of 220 en bloc resections that were performed on 216 patients during that period. Most of the tumors were primary-165 cases (43 benign and 122 malignant), metastases occurred in 55 cases. Median FU was 45 months (0-371). 153 complications were observed in 100 patients (46.2 %). 64 (30 %) suffered one complication, while the rest had two or more. There were 105 major and 48 minor complications. Seven patients (4.6 %) died as a result of complications. The combined approach, neoadjuvant chemotherapy and neoadjuvant radiotherapy were statistically significant independent risk factors for complications occurrence. 33 patients (15.2 %) suffered from local recurrence. Reoperations were mostly due to tumor recurrences, but also to hardware failures, wound dehiscence, hematomas and aortic dissection. CONCLUSION The rate of complication is higher in multisegmental resections and when double combined approach is performed. Reoperations display greater morbidity owing to dissection through scar/fibrosis from previous operations and possibly from RT. Careful treatment planning and, in the event of uncertainty, referral to a specialty center must be stressed. The high risk of complications should not discourage surgeons from performing en bloc resection when needed. Most of the patients who sustain complications benefit from the better local control resulting from en bloc resection.
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Affiliation(s)
- Stefano Boriani
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
| | - Ran Lador
- Spine Surgery Unit, Tel-Aviv Medical Center, 6 Weizman St., 64239, Tel-Aviv, Israel.
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Babashahi A, Taheri M. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 2:64-68. [PMID: 27683698 PMCID: PMC5039842 DOI: 10.21037/jss.2016.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/07/2016] [Indexed: 06/06/2023]
Abstract
Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body. In a follow-up examination approximately one month after surgery, imaging revealed kyphotic deformity and the patient was referred to the Rasoul-e-Akram Hospital. The patient then underwent surgical reconstruction. The postoperative computed tomography (CT) scan showed appropriate repair of sagittal balance and the patient's symptoms gradually improved. Post-laminectomy kyphosis is a notable concern and complication in the pediatric population and can occur shortly after surgery. The following interventions can decrease the likelihood of post-laminectomy kyphosis: minimal muscle dissection and bone removal during laminectomy, avoidance of facet disruption, use of laminoplasty rather than laminectomy, postoperative immobilization/bracing and regular follow-up for early detection and treatment of any deformity.
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Affiliation(s)
- Ali Babashahi
- Iran University of Medical Sciences, Rasoul-e-Akram Hospital, Tehran, Iran
| | - Morteza Taheri
- Iran University of Medical Sciences, Rasoul-e-Akram Hospital, Tehran, Iran
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14
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Abstract
Objective: To present the deformities and evaluate the results of their treatment. Methods: Retrospective study of patients with deformity following surgical access to the spinal canal. Fifteen patients who met the inclusion criteria were included. Patients without complete data in medical records were excluded. Results: Fourteen patients underwent surgical treatment and one patient received conservative treatment with vest type TLSO. The average angle of kyphosis correction was 87° preoperatively to 38° postoperatively, while the associated scoliosis correction was 69° preoperatively to 23° postoperatively. Conclusions: The prevention of deformity should be emphasized to avoid laminectomy alone, while laminoplasty should be the procedure of choice for canal access in surgeries where there is no need for resection of the posterior elements.
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Ahmed R, Menezes AH, Awe OO, Mahaney KB, Torner JC, Weinstein SL. Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr 2014; 13:613-21. [PMID: 24702614 DOI: 10.3171/2014.1.peds13317] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECT Spinal deformity in pediatric patients with intramedullary spinal cord tumors (IMSCTs) may be either due to neurogenic disability or due to secondary effects of spinal decompression. It is associated with functional decline and impairment in health-related quality-of-life measures. The authors sought to identify the long-term incidence of spinal deformity in individuals who had undergone surgery for IMSCTs as pediatric patients and the risk factors and overall outcomes in this population. METHODS Treatment records for pediatric patients (age < 21 years) who underwent surgical treatment for histology-proven primary IMSCTs between 1975 and 2010 were reviewed. All patients were evaluated in consultation with the pediatric orthopedics service. Clinical records were reviewed for baseline and follow-up imaging studies, surgical fusion treatment, and long-term skeletal and disease outcomes. RESULTS The authors identified 55 patients (30 males and 25 females) who were treated for pediatric IMSCTs between January 1975 and January 2010. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2-37.2 years). Preoperative skeletal deformity was diagnosed in 11 (20%) of the 55 patients, and new-onset postoperative deformity was noted in 9 (16%). Conservative management with observation or external bracing was sufficient in 8 (40%) of these 20 cases. Surgical fusion was necessary in 11 (55%). Posterior surgical fusion was sufficient in 6 (55%) of these 11 cases, while combined anterior and posterior fusion was undertaken in 5 (45%). Univariate and multivariate analysis of clinical and surgical treatment variables indicated that preoperative kyphoscoliosis (p = 0.0032) and laminectomy/laminoplasty at more than 4 levels (p = 0.05) were independently associated with development of spinal deformity that necessitated surgical fusion. Functional scores and 10-year disease survival outcomes were similar between the 2 groups. CONCLUSIONS Long-term follow-up is essential to monitor for delayed development of spinal deformity, and regular surveillance imaging is recommended for patients with underlying deformity. The authors' extended follow-up highlights the risk factors associated with development of spinal deformity in patients treated for pediatric IMSCTs. Surgical fusion allows patients who develop progressive deformity to achieve long-term functional and survival outcomes comparable to those of patients who do not develop progressive deformity.
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Lü GH, Li J, Wang XB, Wang B, Phan K. Surgical treatment based on pedicle screw instrumentation for thoracic or lumbar spinal Langerhans cell histiocytosis complicated with neurologic deficit in children. Spine J 2014; 14:768-76. [PMID: 24035731 DOI: 10.1016/j.spinee.2013.06.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/19/2013] [Accepted: 06/29/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical indications and procedures for spinal Langerhans cell histiocytosis (LCH) in children are still controversial. Reports containing large samples of surgically treated patients are few in the currently available literature, and the reported operative procedures were also somewhat obsolete. So, further investigation based on large-sample cases and using improved surgical techniques is beneficial and helpful to refine the treatment strategy. PURPOSE To recommend a reasonable treatment strategy for thoracic or lumbar spine LCH in children complicated with neurologic deficit. STUDY DESIGN/SETTING Retrospective/academic medical center. PATIENT SAMPLE Twelve children aged from 2 to 16 years old with the diagnosis of thoracic or lumbar spinal LCH accompanied by neurologic deficit received surgical treatment from January 2005 to January 2010. OUTCOME MEASURES Frankel scale for neurologic function, fusion of the mass, and recurrence of the lesion. METHODS All 12 patients presented initially with local pain and progressive neurologic detriment. Neurologic evaluation revealed two patients with Frankel Grade B, eight with Grade C, and two with Grade D. Radiographic features were positive for typical vertebra plana, a space-occupying mass in the spinal canal compressing neural elements, and a spinal canal encroachment rate more than 50%. Posterior instrumentation with pedicle screw combined with anterior corpectomy, decompression, and support bone graft was performed in the first seven patients as a one-stage procedure. In the remaining five patients, posterior pedicle screw fixation, laminectomy for decompression (via excision of the tumor-like mass), and repair of laminae with allograft bone block were performed. The collapsed vertebral body was left untouched. No chemotherapy or radiotherapy was administrated postoperatively in any of the cases. RESULTS The mean follow-up duration was 43.3 months. The mean operation time was 330 minutes with combined procedure and 142 minutes with single posterior approach (p=.000). The average blood loss was 933 mL with combined procedure and 497 mL with single posterior approach (p=.039). Three of seven patients who received combined surgery encountered approach-related complications, that is, one with intercostal neuralgia and two with pleural effusion. No severe neurologic deteriorate, instrumentation failure, or disease recurrence was detected at follow-up. Neurologic function completely recovered in all 12 patients from 2 to 12 weeks after surgery. The anterior bone graft fused and shaped well in all seven patients, and allograft bone block for lamina repair also achieved complete fusion in the remaining five patients. The internal fixator was removed at 3 to 5 years (average 4.1 years) after initial operation in six patients. No deformity, including scoliosis and kyphosis, has been identified during follow-up period in both procedures. CONCLUSIONS For spinal LCH patients, neurologic deficit is a main indication for operative treatment to prevent permanent and serious consequences. Surgery provides an opportunity for rapid recovery of neurologic function. Both combined and single-stage posterior approaches based on pedicle screw instrumentation techniques are similarly effective in relieving neurologic compression. However, single-stage posterior approach is more favorable with less complications, and preserving involved vertebral body is not a latent hazard of recurrence.
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Affiliation(s)
- Guo-Hua Lü
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China.
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Kevin Phan
- Department of Orthopaedic Surgery, University of California at Los Angeles, 1250 16th St, Suit 3145, Santa Monica, CA 90404, USA
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Miladi L. Round and angular kyphosis in paediatric patients. Orthop Traumatol Surg Res 2013; 99:S140-9. [PMID: 23287399 DOI: 10.1016/j.otsr.2012.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/24/2012] [Indexed: 02/02/2023]
Abstract
Structural kyphosis is a posterior convex deformity of the spine that may appear in childhood then worsen with growth, most notably during the pubertal growth spurt. The abnormal curvature may be smooth, defining round kyphosis, or may display a sharp angular pattern. Angular kyphosis is the more severe of the two forms. The main causes of round kyphosis are postural kyphosis and Scheuermann's disease. The spontaneous outcome is favourable, and round kyphosis is well tolerated in adulthood. The treatment relies on orthopaedic methods in the overwhelming majority of cases. Surgery is reserved for severe rigid kyphosis in older children and for kyphosis responsible for refractory pain or neurological deficits. Surgical treatment carries a non-negligible risk of neurological, gastrointestinal, mechanical, and septic complications, which should be explained clearly to the family. Advances in contemporary posterior instrumentation have considerably limited the indications for anterior approaches. Many conditions may cause angular kyphosis, whose greater severity is related to a greater potential for progression and neurological impairment. Clinical investigations are in order to identify the cause and to plan the surgical strategy. Early surgery may be indicated, via a combined anterior and posterior approach. Anterior strut grafting, anterior or posterior osteotomies, or even vertebral column resections may be necessary to correct a major deformity.
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Affiliation(s)
- L Miladi
- Service de chirurgie orthopédique Necker-Enfants malades, 149 rue de Sèvres, Paris, France.
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Han K, Lu C, Li J, Xiong GZ, Wang B, Lv GH, Deng YW. Surgical treatment of cervical kyphosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:523-36. [PMID: 20967471 DOI: 10.1007/s00586-010-1602-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/30/2010] [Accepted: 09/29/2010] [Indexed: 01/29/2023]
Abstract
Cervical kyphosis is an uncommon but potentially debilitating and challenging condition. We reviewed the etiology, presentation, clinical and radiological evaluation, and treatment of cervical kyphosis. Based on the current controversy as to the ideal mode of surgical management, we paid particular attention to the available surgical strategies. There are three approaches for cervical kyphosis: the anterior, posterior or combined procedures. The principal indication for the posterior strategy is a flexible kyphosis or kyphosis caused by ankylosing spondylitis. The main point of debate is between the choice of the anterior or the combined strategy. The two strategies were compared with regard to clinical outcome, correction of deformity, rate of fusion, complications, revision surgery, and mortality. The combined strategy appears to result in a greater degree of correction than the anterior-alone strategy, and it is more likely to improve the cervical alignment to achieve a lordosis. However, the procedure carries a higher rate of postoperative neurological deterioration, complications, revision surgery, and mortality. Although the anterior-alone strategy achieves a smaller reduction of cervical kyphosis, it has a lower rate of postoperative neurological deterioration, complications, revision surgery, and mortality. We recommend that the surgical treatment of cervical kyphosis should be planned on an individual basis. A multicenter, prospective, randomized controlled study would be necessary to determine the ideal mode of treatment for complex cervical kyphosis.
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Affiliation(s)
- Ke Han
- Department of Spinal Surgery, Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011 Hunan Province, China
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Ogden AT, Fessler RG. Minimally invasive resection of intramedullary ependymoma: case report. Neurosurgery 2010; 65:E1203-4; discussion E1204. [PMID: 19934940 DOI: 10.1227/01.neu.0000360153.65238.f0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This report illustrates the adequacy of minimally invasive exposure for the resection of an intramedullary ependymoma. CLINICAL PRESENTATION The patient presented with a history of upper back pain, but a lesion was found during a workup for increased back pain after a motor vehicle accident. INTERVENTION The intramedullary ependymoma was approached using a muscle-splitting retractor and extended hemilaminar exposure. The tumor was removed using conventional techniques. CONCLUSION This minimally invasive exposure is adequate for selected intramedullary lesions and may be especially useful in patients with a high risk of postlaminectomy deformity.
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Affiliation(s)
- Alfred T Ogden
- The Neurological Institute, Columbia University, New York, New York 10032, USA.
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Morbidity of en bloc resections in the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:231-41. [PMID: 19690899 DOI: 10.1007/s00586-009-1137-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 06/27/2009] [Accepted: 08/04/2009] [Indexed: 10/24/2022]
Abstract
The morbidity of surgical procedures for spine tumors can be expected to be worse than for other conditions. This is particularly true of en bloc resections, the most technically demanding procedures. A retrospective review of prospective data from a large series of en bloc resections may help to identify risk factors, and therefore to reduce the rate of complications and to improve outcome. A retrospective study of 1,035 patients affected by spine tumors-treated from 1990 to 2007 by the same team-identified 134 patients (53.0% males, age 44 +/- 18 years) who had undergone en bloc resection for primary tumors (90) and bone metastases (44). All clinical, histological and radiological data were recorded from the beginning of the period in a specifically built database. The study was set up to correlate diagnosis, staging and treatment with the outcome. Oncological and functional results were recorded for all patients at periodic, diagnosis-related controls, until death or the latest follow-up examination (from 0 to 211 months, median 47 months, 25th-75th percentile 22-85 months). Forty-seven on the 134 patients (34.3%) suffered a total of 70 complications (0.86 events per 100 patient-years); 32 patients (68.1%) had one complication, while the rest had 2 or more. There were 41 major and 29 minor complications. Three patients (2.2%) died from complications. Of the 35 patients with a recurrent or contaminated tumor, 16 (45.7%) suffered at least one complication; by contrast, complications arose in 31 (31.3%) of the 99 patients who had had no previous treatment and who underwent the whole of their treatment in the same center (P = 0.125). The risk of major complications was seen to be more than twice as high in contaminated patients than in non-contaminated ones (OR = 2.52, 95%CI 1.01-6.30, P = 0.048). Factors significantly affecting the morbidity are multisegmental resections and operations including double contemporary approaches. A local recurrence was recorded in 21 cases (15.7%). The rate of deep infection was higher in patients who had previously undergone radiation therapy (RT), but the global incidence of complications was lower. Re-operations were mostly due to tumor recurrences, but also to hardware failures, wound dehiscence, hematomas and aortic dissection. En bloc resection is able to improve the prognosis of aggressive benign and low-grade malignant tumors in the spine; however, complications are not rare and possibly fatal. The rate of complication is higher in multisegmental resections and when double combined approach is performed, as it can be expected in more complex procedures. Re-operations display greater morbidity owing to dissection through scar/fibrosis from previous operations and possibly from RT. The treatment of recurrent cases and planned transgression to reduce surgical aggressiveness are associated with a higher rate of local recurrence, which can be considered the most severe complication. In terms of survival and quality of life, late results are worse in recurrent cases than in complicated cases. Careful treatment planning and, in the event of uncertainty, referral to a specialty center must be stressed.
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Kunieda E, Nishimura G, Kaneko T, Hirobe S, Masaki H, Kamagata S. Spinal deformity after intra-operative radiotherapy for paediatric patients. Br J Radiol 2009; 83:59-66. [PMID: 19690075 DOI: 10.1259/bjr/50353703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to clarify the incidence and characteristics of late-onset complications of the spine in children who underwent intra-operative radiation therapy (IORT) for common paediatric malignant tumours. 12 children with more than 4 years of follow-up after IORT were included and, in 11 of these, thoracic and/or lumbar spines were irradiated. To compare doses of irradiation to the spine with the resulting deformities, dose simulations of IORT were carried out on two selected cases using a radiation treatment planning system with a pencil-beam algorithm. The mean follow-up period was 135 months (range, 53-234 months). Radiographic reviews found spinal deformity in six patients. Only one patient was symptomatic and the spinal deformity was severe (Grade 3), whereas spinal deformity was mild in the remaining five patients without clinical symptoms (Grade 1). In all of the six patients, anterior wedge-shaped deformity was dominant, and scoliosis was found in only two patients. In one particular case with nephrectomy, irradiation had penetrated much deeper than usual at the site of nephrectomy, and dose distribution was asymmetric, causing clinically significant spinal deformity with scoliosis. In conclusion, specific deformities of the spine observed after IORT can be explained on the basis of dose distribution of the electron beam to the spine.
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Affiliation(s)
- E Kunieda
- Department of Radiology, Keio University, Tokyo, Japan.
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Bandiera S, Boriani S, Donthineni R, Amendola L, Cappuccio M, Gasbarrini A. Complications of en bloc resections in the spine. Orthop Clin North Am 2009; 40:125-31, vii. [PMID: 19064060 DOI: 10.1016/j.ocl.2008.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Morbidity of surgical procedures for spine tumors is expected to be worse than for other conditions. This is particularly true for en bloc resections, a technically demanding procedure. En bloc resections can help improve the prognosis of aggressive benign and malignant tumors in the spine, but the related morbidity is high and sometimes fatal. Reoperations have higher risks because of dissection through scar/fibrosis from previous surgeries and possibly from radiation. Careful planning for treatment is mandatory, and if the surgeon is unsure, referral to a specialty center is necessary.
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Aizawa T, Sato T, Ozawa H, Morozumi N, Matsumoto F, Sasaki H, Hoshikawa T, Kawahara C, Kokubun S, Itoi E. Sagittal alignment changes after thoracic laminectomy in adults. J Neurosurg Spine 2008; 8:510-6. [DOI: 10.3171/spi/2008/8/6/510] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The increased kyphosis after thoracic laminectomy in adult patients was retrospectively evaluated and various factors affecting this spinal deformity were analyzed.
Methods
The authors conducted a retrospective study of 58 cases in which laminectomy was performed and more than half of the facet joints were left intact. The study group included 44 men (mean age 59 years) and 14 women (mean age 61 years) with thoracic myelopathy due to ossifications of the ligamentum flavum and/or the posterior longitudinal ligament or due to posterior bone spurs. Patients were followed up for a minimum of 2 years. Their neurological condition was evaluated using the Japanese Orthopaedic Association (JOA) scale (a full score is 11), and the magnitude of local kyphosis in the laminectomized area was determined using the Cobb angle method.
Results
The mean preoperative JOA score was 5.4; the mean postoperative score was 8.3. No relationship was found between postoperative JOA score and increased kyphotic angle. The mean preoperative kyphotic angle was 7.0°. The mean postoperative kyphotic angle was 10.8°. Thus local kyphosis in the treated area increased by only 3.8°. The mean increase in kyphosis per spinal segment, calculated by dividing the kyphotic angle of the surgically decompressed area by the number of resected laminae, was 1.9°. Female patients with ≥ 3-level laminectomies showed a significant increase of kyphosis in both the laminectomized area and each spinal segment.
Conclusions
The increase in kyphosis after thoracic laminectomy is not large and thus spinal fusion is usually not necessary. In cases involving female patients who undergo long-segment laminectomies, however, careful radiographic follow-up is recommended.
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Affiliation(s)
- Toshimi Aizawa
- 1Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Tetsuro Sato
- 2Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital
| | - Hiroshi Ozawa
- 1Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Naoki Morozumi
- 3Department of Orthopaedic Surgery, Nishitaga National Hospital; and
| | - Fujio Matsumoto
- 4Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | | | - Takeshi Hoshikawa
- 1Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Chikashi Kawahara
- 1Department of Orthopaedic Surgery, Tohoku University School of Medicine
| | - Shoichi Kokubun
- 3Department of Orthopaedic Surgery, Nishitaga National Hospital; and
| | - Eiji Itoi
- 1Department of Orthopaedic Surgery, Tohoku University School of Medicine
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Agabegi SS, Antekeier DP, Crawford AH, Crone KR. Postlaminectomy kyphosis in an achondroplastic adolescent treated for spinal stenosis. Orthopedics 2008; 31:168. [PMID: 19292200 DOI: 10.3928/01477447-20080201-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a case of a skeletally immature achondroplastic adolescent with significant thoracolumbar lordosis who presented with neurogenic claudication and urinary incontinence progressing over a 1-year period. She underwent decompressive lumbar laminectomy from T12 to L5 with preservation of the facet joints. Over the ensuing 4 years of follow-up, she developed a progressive thoracolumbar kyphosis that progressed to 105 degrees. She remained neurologically intact and was fully ambulatory, but had severe back pain in the area of the deformity. Because of the severity and progression of her deformity, a combined anterior and posterior fusion and stabilization was required. We present this case and a review of the literature on spinal stenosis in achondroplasia and the complication of post-laminectomy kyphosis.
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Affiliation(s)
- Steven S Agabegi
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Abstract
The VATER/VACTERL association is a syndrome notable for congenital vertebral malformations, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, and renal or limb malformations. Vertebral malformations may include the entire spectrum of congenital spinal deformities, including kyphosis, as was seen in this case. A 14-year-old girl presented to our institution with severe rigid sagittal deformity in the thoracolumbar spine that had recurred following three prior spinal fusion surgeries: the first posterior only, the second anterior and posterior, and the third a posterior only proximal extension. These surgeries were performed to control progressive kyphosis from a complex failure of segmentation that resulted in a 66 degrees kyphosis from T11 to L3 by the time she was 9 years old. Our evaluation revealed solid arthrodesis from the most recent procedures with resultant sagittal imbalance, and surgical options to restore balance included anterior and posterior revision spinal fusion with osteotomies, multiple posterior extension osteotomies with circumferential spine fusion, and posterior vertebral column resection with circumferential spine fusion. She was advised that multiple posterior extension osteotomies would likely be insufficient to restore sagittal balance in the setting of solid arthrodesis from anterior and posterior surgery, and that the posterior-only vertebral column resection would provide results equivalent to revision anterior and posterior surgery, without the morbidity of the anterior approach. She successfully underwent posterior vertebrectomy and circumferential spinal fusion with instrumentation and is doing well 2 years postoperatively. Severe rigid sagittal deformity can be effectively managed with a posterior-only surgical approach, vertebrectomy, and circumferential spinal fusion with instrumentation.
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de Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illés T. Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:765-71. [PMID: 16012842 PMCID: PMC3489260 DOI: 10.1007/s00586-004-0778-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2002] [Revised: 06/04/2004] [Accepted: 06/11/2004] [Indexed: 01/01/2023]
Abstract
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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Affiliation(s)
- Tamás de Jonge
- Department of Pediatric Orthopaedic Surgery, Saint Vincent de Paul Hospital, Paris, France.
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