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Spinal deformity after resection of cervical intramedullary spinal cord tumors in children
Matthew J McGirt1, Kaisorn L Chaichana, Frank Attenello
1Department of Neurosurgery, Johns Hopkins School of Medicine, 3553 Newland Rd., Baltimore, MD 21218, USA. mmcgirt1@jhmi.edu
Insights
Pediatric patients undergoing cervical intramedullary spinal cord tumor (IMSCT) resection are at risk for progressive spinal deformity. Younger age and extensive decompression increase this risk, necessitating close monitoring.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Spinal Surgery
Background:
- Progressive spinal deformity is a common complication following cervical intramedullary spinal cord tumor (IMSCT) resection in pediatric patients.
- Identifying risk factors for this deformity is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To identify specific patient subgroups at higher risk for developing progressive spinal deformity after cervical IMSCT resection.
- To analyze clinical, radiographic, and operative variables associated with the development of such deformities.
Main Methods:
- Retrospective analysis of 58 pediatric patients who underwent cervical IMSCT resection.
- Kaplan-Meier plots, Log-rank, and Cox analyses were used to assess the association of variables with progressive spinal deformity over time.
Main Results:
- 19% of patients required subsequent spinal fusion for progressive deformity.
- Patients under 13 years old were over three times more likely to develop deformity (p=0.05).
- Decompression involving both the C1-C2 and C7-T1 regions significantly increased deformity risk (p=0.04).
Conclusions:
- Younger age and extensive cervical/cervicothoracic decompression are significant risk factors for progressive spinal deformity post-IMSCT resection.
- Patients with these characteristics require vigilant monitoring for spinal deformity after surgery.
Objective:
Progressive spinal deformity after cervical intramedullary spinal cord tumor (IMSCT) resection requiring subsequent fusion occurs in many cases among pediatric patients. It remains unknown which subgroups of patients represent the greatest risk for progressive spinal deformity.
Materials And Methods:
The data for 58 patients undergoing surgical resection of cervical IMSCT at a single institution were retrospectively collected and analyzed for development of progressive spinal deformity requiring fusion. The association of all clinical, radiographic, and operative variables to subsequent progressive spinal deformity as a function of time was assessed via Kaplan-Meier plots and Log-rank and Cox analyses.
Results:
Mean age at the time of surgery was 11 +/- 6 years. Eleven (19%) patients required subsequent fusion for progressive spinal deformity at a median [interquartile range (IQR)] of 4 (2-6) years after IMSCT resection. Five (36%) of 14 patients with preoperative scoliosis or loss of lordosis developed postoperative progressive spinal deformity compared to only 6 (13%) of 44 patients with normal preoperative sagittal and coronal balance, p = 0.06. Patients <13 years of age were more than three times more likely to develop postoperative progressive deformity, p = 0.05. Decompression spanning both the axial cervical spine (C1-C2) and the cervico-thoracic junction (C7-T1) increased the risk for progressive spinal deformity fourfold, p = 0.04. Number of spinal levels decompressed, revision surgery, radiotherapy, involvement of C1-C2 or C7-T1 alone in the decompression, or any other recorded variables were not associated with progressive postoperative spinal deformity.
Conclusion:
Patients possessing one or more of these characteristics should be monitored closely for progressive spinal deformity after surgery.
