Primary bone tumors of the spine in children

Tumors originating in the vertebrae in children are difficult to treat. In this paper the authors sought to evaluate the decision-making process and outcome of surgical intervention in this population given the complex issues of spinal stability, continued skeletal growth, intraoperative blood loss, and long-term outcome.

To select patients for this study, the authors retrospectively reviewed medical records and images at the University of Iowa Hospitals and Clinics between 1996 and 2005. Their inclusion criteria were age younger than 18 years at the time of diagnosis and histopathological findings confirming that the tumor originated from vertebral bone. Sixteen patients met these requirements. In addition, the authors conducted a comparison with 45 patients in whom similar diagnoses were made prior to 1996. Gross-total resection of all nonmetastatic primary bone tumors is desired, as exemplified in 11 patients in this series; biopsy sampling only was performed in two others. Gross-total resection was also not performed in three patients with eosinophilic granuloma (EG). These three patients underwent nonsurgical treatment, which is different from how patients with EG were treated in the earlier study. Nine histopathological diagnoses were included; with a mean follow-up period of 3.7 years, the survival rate is 94%. The tumor recurred in one patient with a giant cell tumor of the sacrum. The authors performed preoperative tumor embolization and found that it was a useful adjunct to resection. Provocative testing prior to embolization was part of the protocol to reduce ischemic complications. Motion-sparing surgical procedures were performed in which a few segments were fused, preserving axial mobility.

Overall, early intervention offers the best symptomatic relief, which can only be rendered if sufficient clinical suspicion provokes early diagnostic imaging.