Correlation of a preoperative grading scale with progressive spinal deformity following surgery for intramedullary spinal cord tumors in children

Clinical article

Restricted access


Postoperative progressive spinal deformity often complicates functional outcome after resection of pediatric intramedullary spinal cord tumors (IMSCTs). The authors propose a preoperative grading scale that correlates with the postoperative development of progressive spinal deformity requiring subsequent fusion.


The data obtained in 164 patients who underwent resection of an IMSCT at a single institution were retrospectively collected and analyzed to determine the development of progressive spinal deformity requiring fusion. A grading scale (range of scores I–V) was created based on the presence or absence of 4 preoperative variables: preoperative scoliosis, involvement of the thorocolumbar junction, age < 13 years, and number of surgeries for an IMSCT. The grading scale was then retrospectively applied to this series of 164 children to assess the correlation of variables with subsequent spinal deformity.


Nine patients presented with Grade I status, 41 patients with Grade II, 58 patients with Grade III, 44 patients with Grade IV, and 12 patients with Grade V. Overall, 44 patients (27%) developed progressive spinal deformity requiring fusion at a mean follow-up of 5 years after surgery. A higher preoperative grade was associated with an increasing need for subsequent fusion for progressive spinal deformity (Grade I [0%], Grade II [5%], Grade III [26%], Grade IV [40%], and Grade V status [75%]).


Application of this grading scheme to a series of resected pediatric IMSCTs has demonstrated its correlation with the incidence of postoperative progressive spinal deformity requiring fusion. The application of a standardized grading scheme will assist in the process of surgical decision making and postoperative evaluation.

Abbreviations used in this paper: IMSCT = intramedullary spinal cord tumor; TLJ = thoracolumbar junction.

Article Information

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

© AANS, except where prohibited by US copyright law.



  • 1

    Albert TJVacarro A: Postlaminectomy kyphosis. Spine 23:273827451998

  • 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

  • 3

    Bell DFWalker JLO'Connor GTibshirani R: Spinal deformity after multiple-level cervical laminectomy in children. Spine 19:4064111994

  • 4

    Bowers DCWeprin BE: Intramedullary spinal cord tumors. Curr Treat Options Neurol 5:2072122003

  • 5

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

  • 6

    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

  • 7

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

  • 8

    Duffner PKKun LEBurger PCHorowitz MECohen MESanford RA: Postoperative chemotherapy and delayed radiation in infants and very young children with choroid plexus carcinomas. The Pediatric Oncology Group. Pediatr Neurosurg 22:1891961995

  • 9

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

  • 10

    Fischer GBrotchi JChignier GLiard AZomosa GMenei P: Intramedullary spinal cord tumors. Fischer GBrotchi J: Epidemiology StuttgartThieme1996. 910

  • 11

    Ford DMBagnall KMMcFadden KDGreenhill BJRaso VJ: Paraspinal muscle imbalance in adolescent idiopathic scoliosis. Spine 9:3733761984

  • 12

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

  • 13

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

  • 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

    Kaptain GJSimmons NEReplogle REPobereskin L: Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 93:2 Suppl1992042000

  • 17

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

  • 18

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

  • 19

    Meir ARFairbank JCJones DAMcNally DSUrban JP: High pressures and asymmetrical stresses in the scoliotic disc in the absence of muscle loading. Scoliosis 2:42007

  • 20

    Mikawa YShikata JYamamuro T: Spinal deformity and instability after multilevel cervical laminectomy. Spine 12:6111987

  • 21

    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

  • 22

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

  • 23

    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

  • 24

    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

  • 25

    Stokes IASpence HAronsson DDKilmer N: Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine 21:116211671996

  • 26

    Takemura YYamamoto HTani T: Biomechanical study of the development of scoliosis, using a thoracolumbar spine model. J Orthop Sci 4:4394451999

  • 27

    Yao KCMcGirt MJChaichana KLConstantini SJallo GI: Risk factors for progressive spinal deformity following surgical resection of intramedullary spinal cord tumors in children: analysis of 161 consecutive cases. J Neurosurg 107:6 Suppl4634682007

  • 28

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




All Time Past Year Past 30 Days
Abstract Views 80 80 4
Full Text Views 57 57 3
PDF Downloads 84 84 2
EPUB Downloads 0 0 0


Google Scholar