Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

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Object

Gross-total resection of pediatric intramedullary spinal cord tumor (IMSCT) can be achieved in the majority of cases while preserving long-term neurological function. Nevertheless, postoperative progressive spinal deformity often complicates functional outcome years after surgery. The authors set out to determine whether laminoplasty in comparison with laminectomy has reduced the incidence of subsequent spinal deformity requiring fusion after IMSCT resection at their institution.

Methods

The first 144 consecutive patients undergoing resection of IMSCTs at a single institution underwent laminectomy with preservation of facet joints. The next 20 consecutive patients presenting for resection of IMSCTs underwent osteoplastic laminotomy regardless of patient or tumor characteristics. All patients were followed up with telephone interviews corroborated by medical records for the following outcomes: 1) neurological and functional status (modified McCormick Scale [MMS] score and Karnofsky Performance Scale [KPS] score); and 2) development of progressive spinal deformity requiring fusion. The incidence of progressive spinal deformity and the long-term neurological function were compared between the laminectomy and osteoplastic laminotomy cohorts. The means are expressed ± the standard deviation.

Results

Overall, the patients' mean age was 8.6 ± 5 years, and they presented with median MMS scores of 2 (interquartile range [IQR] 2–4). A > 95% resection was achieved in 125 cases (76%). There were no differences (p > 0.10) between patients treated with osteoplastic laminotomy and those treated with laminectomy in terms of the following characteristics: age; sex; duration of symptoms; location of tumor; incidence of preoperative scoliosis (Cobb angle > 10°: 7 [35%] with laminoplasty compared with 49 [34%] with laminectomy); involvement of the cervicothoracic junction (7 [35%] compared with 57 [40%]); thoracolumbar junction (4 [20%] compared with 36 [25%]); tumor size; extent of resection; radiation therapy; histopathological findings; or mean operative spinal levels (7.5 ± 2 compared with 7.5 ± 3). Nevertheless, patients who underwent osteoplastic laminotomy had better median preoperative MMS scores than those treated with laminectomy (2 [IQR 2–2] compared with 2 [IQR 2–4]; p = 0.04). A median of 3.5 years (IQR 1–7 years) after surgery, only 1 patient (5%) in the osteoplastic laminotomy cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (p = 0.027). Adjusting for the inter-cohort difference in preoperative MMS scores, osteoplastic laminotomy was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, 95% confidence interval 0.02–1.00; p = 0.05). The median MMS and KPS scores were similar between patients who underwent osteoplastic laminotomy and those in whom laminectomy was performed (MMS Score 2 [IQR 2–3] for laminotomy compared with 2 [IQR 2–4] for laminectomy, p = 0.54; KPS Score 90 [IQR 70–100] for laminotomy compared with 90 [IQR 80–90] for laminectomy, p = 0.545) at a median of 3.5 years after surgery.

Conclusions

In the authors' experience, osteoplastic laminotomy for the resection of IMSCT in children was associated with a decreased incidence of progressive spinal deformity requiring fusion but did not affect long-term functional outcome. Laminoplasty used for pediatric IMSCT resection may decrease the incidence of progressive spinal deformity requiring subsequent spinal stabilization in some patients.

Abbreviations used in this paper: CSF = cerebrospinal fluid; IMSCT = intramedullary spinal cord tumor; IQR = interquartile range; KPS = Karnofsky Performance Scale; MMS = modified Mc-Cormick Scale; MR = magnetic resonance.
Article Information

Contributor Notes

Address correspondence to: Matthew J. McGirt, M.D., 3553 Newland Road, Baltimore, Maryland 21218. email: mmcgirt1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Abbott RFeldstein NWisoff JHEpstein FJ: Osteoplastic laminotomy in children. Pediatr Neurosurg 18:1531561992

  • 2

    Barker DJWeller ROGarfield JS: Epidemiology of primary tumors of the brain and spinal cord: a regional survey in southern England. J Neurol Neurosurg Psychiatry 39:2902961976

    • Search Google Scholar
    • Export Citation
  • 3

    Constantini SHouten JMiller DCFreed DOzek MMRorke LB: Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 85:103610431996

    • Search Google Scholar
    • Export Citation
  • 4

    Constantini SMiller DCAllen JCRorke LBFreed DEpstein FJ: Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93:2 Suppl1831932000

    • Search Google Scholar
    • Export Citation
  • 5

    de Jonge TSlullitel HDubousset JMiladi LWicart PIllés T: Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumors. Eur Spine J 14:7657712005

    • Search Google Scholar
    • Export Citation
  • 6

    Elsberg CABeer E: The operability of intramedullary tumors of the spinal cord. A report of two operations with remarks upon the strusion of intraspinal tumors. Am J Med Sci 142:6366471911

    • Search Google Scholar
    • Export Citation
  • 7

    Epstein FEpstein N: Surgical management of holocord intra-medullary spinal cord astrocytomas in children. J Neurosurg 54:8298321981

    • Search Google Scholar
    • Export Citation
  • 8

    Epstein FJFarmer JPFreed D: Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77:3553591992

  • 9

    Fassett DRClark RBrockmeyer DLSchmidt MH: Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus 20:2E22006

    • Search Google Scholar
    • Export Citation
  • 10

    Fraser RDPaterson DCSimpson DA: Orthopaedic aspects of spinal tumors in children. J Bone Joint Surg Br 59:1431511977

  • 11

    Heller JGEdwards CC IIMurakami HRodts GE: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26:133013362001

    • Search Google Scholar
    • Export Citation
  • 12

    Hukuda SOgata MMochizuki TShichikawa K: Laminectomy versus laminoplasty for cervical myelopathy: brief report. J Bone Joint Surg Br 70:3253261988

    • Search Google Scholar
    • Export Citation
  • 13

    Jallo GIDanish SVelasquez LEpstein F: Intramedullary low-grade astrocytomas: long-term outcome following radical surgery. J Neurooncol 53:61662001

    • Search Google Scholar
    • Export Citation
  • 14

    Jallo GIFreed DEpstein F: Intramedullary spinal cord tumors in children. Childs Nerv Syst 19:6416492003

  • 15

    Jallo GIFreed DEpstein FJ: Spinal cord gangliogliomas: a review of 56 patients. J Neurooncol 68:71772004

  • 16

    Jallo GIKothbauer KFEpstein FJ: Intrinsic spinal cord tumor resection. Neurosurgery 49:112411282001

  • 17

    Katsumi YHonma TNakamura T: Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine 14:117111761989

    • Search Google Scholar
    • Export Citation
  • 18

    Lunardi PLicastro GMissori PFerrante LFortuna A: Management of intramedullary tumors in children. Acta Neurochir (Wien) 120:59651993

    • Search Google Scholar
    • Export Citation
  • 19

    McCormick PCTorres RPost KDStein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72:5235321990

  • 20

    Meyer NJFlatley TJDunn DD: Superiorly based laminoplasty in children: average 6.8-year follow-up of 21 patients. J Spinal Disord Tech 16:1561622003

    • Search Google Scholar
    • Export Citation
  • 21

    Nowinski GPVisarius HNolte LPHerkowitz HN: A biomechanical comparison of cervical laminaplasty and cervical laminectomy with progressive facetectomy. Spine 18:199520041993

    • Search Google Scholar
    • Export Citation
  • 22

    Papagelopoulos PJPeterson HAEbersold MJEmmanuel PRChoudhury SNQuast LM: Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine 22:4424511997

    • Search Google Scholar
    • Export Citation
  • 23

    Raimondi AJGutierrez FADi Rocco C: Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J Neurosurg 45:5555601976

    • Search Google Scholar
    • Export Citation
  • 24

    Ratliff JKCooper PR: Cervical laminoplasty: a critical review. J Neurosurg 98:3 Suppl2302382003

  • 25

    Reimer ROnofrio BM: Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63:6696751985

  • 26

    Saito TYamamuro TShikata JOka MTsutsumi S: Analysis and prevention of spinal column deformity following cervical laminectomy. I. Pathogenetic analysis of postlaminectomy deformities. Spine 16:4945021991

    • Search Google Scholar
    • Export Citation
  • 27

    Schag CCHeinrich RLGanz PA: Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 2:1871931984

    • Search Google Scholar
    • Export Citation
  • 28

    Shrivastava RKEpstein FJPerin NIPost KDJallo GI: Intra-medullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine 2:2492552005

    • Search Google Scholar
    • Export Citation
  • 29

    Spiegel DALoder RTAlley KARowley SGutknecht SSmith-Wright DL: Spinal deformity following selective dorsal rhizotomy. J Pediatr Orthop 24:30362004

    • Search Google Scholar
    • Export Citation
  • 30

    Steinbok PCochrane DDPoskitt K: Intramedullary spinal cord tumors in children. Neurosurg Clin N Am 3:9319451992

  • 31

    Yao KCMcGirt MJChaichana KLConstantini SJallo GI: Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children: an analysis of 161 consecutive cases. J Neurosurg 107:6 Suppl Pediatrics4634682007

    • Search Google Scholar
    • Export Citation
  • 32

    Yeh JSSgouros SWalsh ARHockley AD: Spinal sagittal mal-alignment following surgery for primary intramedullary tumors in children. Pediatr Neurosurg 35:3183242001

    • Search Google Scholar
    • Export Citation
  • 33

    Zdeblick TAZou DWarden KEMcCabe RKunz DVander-by R: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 74:22271992

    • Search Google Scholar
    • Export Citation
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