✓ Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior–posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.
Daniel R. Fassett, Randy Clark, Douglas L. Brockmeyer and Meic H. Schmidt
Wayne M. Gluf and Douglas L. Brockmeyer
occipitocervical fusions in children is the patient's postoperative growth potential or potential for spinal deformity. Previously, it has been shown that pediatric cervical spine growth potential after approximately 10 years of age is very small. 1, 17 With younger patients, however, more careful analysis is required. It has been our experience that once successful fusion is achieved at either the atlantoaxial or occipitocervical level, “growth arrest” occurs. If the bone in the area of fusion subsequently grows a small amount, it remodels around the hardware and no
Vijay M. Ravindra, Kaine Onwuzulike, Robert S. Heller, Robert Quigley, John Smith, Andrew T. Dailey and Douglas L. Brockmeyer
neurological deficit, a left apical curve, kyphotic deformity associated with the curve, or early onset. 16 Known risk factors for curve progression and early spinal fusion include older age at presentation, level of spinal deformity, less syrinx resolution, and greater degree of initial scoliosis. 2 , 3 , 16 , 24 , 27 Previous reports have addressed the short-term response of CRS to suboccipital decompression and duraplasty (SODD). 3 , 5 , 6 , 8 , 18 , 33 , 35 The aim of the current study was to investigate the long-term behavior of CRS in a cohort of patients who
Paul Klimo Jr., Richard C. E. Anderson and Douglas L. Brockmeyer
C ongenital spinal anomalies are relatively common. It has been estimated that 5% of fetuses have vertebral anomalies. Additionally, 3% of healthy adults have one or two more than the usual complement of vertebral segments and approximately 2% have one less. Congenital spinal lesions may indicate the presence of other anomalies. Patients with congenital spinal deformities have a high incidence of intraspinal pathological conditions (30–35%), such as a tethered cord and anomalies in other organ systems (20–25%), namely cardiac and urogenital abnormalities
Richard C. E. Anderson, Peter Kan, Wayne M. Gluf and Douglas L. Brockmeyer
deformity after posterior spinal arthrodesis (that is, the crankshaft phenomenon) has been well described for thoracic and lumbar scoliosis. 1 , 11 Although the effects of posterior fusion in the cervical spine are not as well understood, it has been reported that the following conditions are more likely to develop in children who undergo C1–2 posterior fusion than those who do not: abnormal curvature of the cervical spine, instability in the nonfused levels below the fusion, and disturbance of growth of the fused vertebrae. 7 , 13 Authors of most studies, however, have
James K. Liu, Douglas L. Brockmeyer, Andrew T. Dailey and Meic H. Schmidt
Aneurysmal bone cysts of the spine are benign, highly vascular osseous lesions of unknown origin that may present difficult diagnostic and therapeutic challenges. They are expansile lesions containing thin-walled, blood-filled cystic cavities that cause bone destruction and sometimes spinal deformity and neurological compromise. The treatment of aneurysmal bone cysts of the spine remains controversial according to the literature. In this review, the authors discuss the clinical manifestations, pathophysiological features, neuroimaging characteristics, and treatment strategies for these lesions.
Treatment options include simple curettage with bone grafting, complete excision, embolization, and radiation therapy. Reconstruction and stabilization of the spine may be warranted if deformity and instability are present. Special factors need to be considered in the management of these lesions.
Complete excision of aneurysmal bone cysts offers the best chance of cure and spinal decompression if neurological deficits are present.
Vijay M. Ravindra, Ilyas M. Eli, Meic H. Schmidt and Douglas L. Brockmeyer
. Clinical Symptoms Tumors of the spinal column can present with neurological dysfunction or osseous destruction. In either scenario, the result can be pain, neurological deficit, or rapidly progressive spinal deformity. 33 , 45 , 81 Pediatric patients often present with axial or radicular symptoms, most commonly pain. The timing of symptoms can vary based on pathology. Acute onset can indicate vertebral collapse and potential epidural spinal cord compression, whereas chronic symptoms can be present in the setting of slow-growing tumors. In either scenario, persistent
Douglas L. Brockmeyer
malformation-associated scoliosis: risk factors and time course of deformity progression . J Neurosurg Pediatr 1 : 456 – 460 , 2008 2 Brockmeyer D , Gollogly S , Smith JT : Scoliosis associated with Chiari 1 malformations: the effect of suboccipital decompression on scoliosis curve progression: a preliminary study . Spine 28 : 2505 – 2509 , 2003 3 Dauser RC , DiPietro MA , Venes JL : Symptomatic Chiari I malformation in childhood: a report of 7 cases . Pediatr Neurosci 14 : 184 – 190 , 1988 4 Eule JM , Erickson MA , O'Brien MF
Douglas L. Brockmeyer, Meghan M. Brockmeyer and Taryn Bragg
; 2) the spinal area was not initially unstable, but the instability “unmasked” itself over time; or 3) the patient's parents were initially reluctant to pursue stabilization but eventually made the decision to proceed. During the monitoring period, the patients underwent serial flexion-extension cervical radiography every 6–12 months to determine whether progressive occipitocervical instability or deformity was present. Patients with known gross occipitocervical instability at the time of diagnosis who were too small to undergo operative stabilization (Cases 4, 8
Daniel Couture, Nathan Avery and Douglas L. Brockmeyer
. Recombinant bone morphogenetic protein was not used in any patient. Only one patient required the use of a halo orthosis device. All other patients were placed in a hard collar postoperatively for 2–3 months. All 22 patients underwent successful arthrodesis, with a mean time to fusion of 4.3 months (range 4–6 months) ( Table 2 ). There were no cases of postoperative kyphotic or swan-neck deformity, no asymmetrical (vertical or lateral) growth, and no juxtafusion pathological conditions. Surgical Complications Three patients in our series had complications that