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Published on: September 16, 2022
Spinal deformity following surgery for paediatric intramedullary spinal cord tumours
Florence Hogg1,2, Stewart Tucker3, Mark Harris3
1Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK. florencehogg@me.com.
Insights
Spinal deformity (SD) is common in children with low-grade intramedullary spinal cord tumors (IMSCT), affecting one-third at presentation and two-thirds post-operatively. Risk factors include initial deformity, thoracic location, and syrinx presence.
Area of Science:
- Pediatric Neurosurgery
- Spinal Oncology
- Orthopedic Surgery
Background:
- Spinal deformity (SD) is a significant complication in children with intramedullary spinal cord tumors (IMSCT), arising from neurogenic and mechanical factors.
- The developing spine is susceptible to deformity, impacting quality of life and potentially hindering crucial MRI surveillance post-treatment.
- Identifying risk factors for SD is vital for optimizing surgical planning, patient counseling, and long-term management strategies.
Purpose of the Study:
- To identify risk factors associated with spinal deformity (SD) in pediatric patients undergoing surgery for low-grade intramedullary spinal cord tumors (IMSCT).
- To determine if any identified risk factors are modifiable, aiming to improve pre-operative counseling and surveillance protocols.
- To analyze the incidence and progression of SD in this patient cohort.
Main Methods:
- Retrospective review of 45 pediatric patients (<16 years) with benign IMSCT from a prospectively collected institutional database.
- Analysis of presenting symptoms, spinal deformity at diagnosis, tumor histology, and surgical approach (laminectomy/laminoplasty).
- Evaluation of spinal alignment, need for bracing or surgery for deformity, and correlation of risk factors using statistical analysis.
Main Results:
- Spinal deformity (SD) was present in 38% of patients at diagnosis and occurred post-operatively in 69%.
- Patients presenting with SD were significantly more likely to require spinal fusion (p<0.01).
- Thoracic tumor location and the presence of a syrinx were identified as significant risk factors for progressive SD.
Conclusions:
- Spinal deformity (SD) is highly prevalent in children with low-grade intramedullary spinal cord tumors (IMSCT), necessitating careful monitoring.
- Approximately one-third of patients require spinal fusion for deformity correction, highlighting the long-term impact of these tumors.
- Pre-existing spinal deformity, thoracic tumor location, and syrinx presence are key risk factors for developing and worsening SD.
Objective:
Spinal deformity (SD) in children with intramedullary spinal cord tumours (IMSCT) can occur at presentation or postoperatively due to neurogenic and mechanical factors on a background of future spinal growth. Deformity is associated with pain, functional decline and reduced quality of life but spinal instrumentation can compromise MRI tumour surveillance. This study aims to identify risk factors for SD amongst children operated for low-grade IMSCT to identify any modifiable risk factors and help guide pre-operative counselling and surveillance.
Methods:
Cases of benign IMSCT in patients under 16 were identified from a prospectively collected institutional operative database. Review of electronic medical records was then undertaken for details of presenting symptoms, SD at diagnosis, histology, surgical approach (laminectomy/laminoplasty). High grade tumours and previously operated tumours were excluded. Outcome measures comprised spinal alignment at last follow-up and any additional interventions (bracing or surgery) to address deformity. Data was analysed using Excel and SPSS.
Results:
45 patients satisfied the inclusion criteria. Mean age at index surgery was 7.1 years, and at last follow up 13.8 years. At presentation, 38% had SD (N = 17/45), 11% torticollis (n = 5/45), 64% pain (n = 30/45) and 43% weakness (n = 19/45). Tumour location was thoracic (40%, n = 18/45)), cervicothoracic (33%, n = 14/45) and cervical (27%, n = 12/45). Tumour histology included low-grade astrocytoma (66%, n = 30/45), glioneuronal tumour (13%, n = 6/45), ependymoma (7%, n = 3/45), cavernoma (4%, n = 2/45), haemangioblastoma (2%, n = 2/45) and neuroenteric cyst (2%, n = 1/45), Laminoplasty was performed in all cases, 51% (n = 23/45) crossing a junctional level. Postoperative MRI confirmed total resection in 51% (n = 23/45). 43% received adjuvant therapy (n = 19/45). 85% (n = 38/45) wore a post-operative spinal orthosis for mean duration 5.27 months (range 1.5-36 months). Postoperative SD occurred in 69% (n = 31/45) of which 48% (n = 15/31) developed following surgery, typically within 2.6 years of follow up. 42% required further bracing (n = 19/45) and 31% underwent spinal fusion (n = 14/45) at an average of 5.5 years post-resection. Patients presenting with SD were significantly more likely to require spinal fusion (p = < 0.01). Thoracic location and the presence of a syrinx were also risk factors for progressive SD.
Conclusions:
SD is common in children with low-grade IMSCT in children affecting one third at presentation and two thirds post-operatively with one third requiring spinal fusion for deformity correction. Risk factors include: SD at presentation, thoracic cord location and presence of syrinx.
