Instrumented fusion for spinal deformity after laminectomy or laminoplasty for resection of intramedullary spinal cord tumors in pediatric patients

Hersh, David S.; Iyer, Rajiv R.; Garzón-Muvdi, Tomás; Liu, Ann; Jallo, George I.; Groves, Mari L.

doi:10.3171/2017.7.focus17329

Cited by 37 publications

(25 citation statements)

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“…Удовлетворительные клинические результаты после декомпрессии без стабилизации описаны у пациентов с МПС IV [30] и VI [36] типов, хотя данная тактика представляется рискованной в связи с вероятностью развития нестабильности в других отделах [17,19,37]. Сообщается о развитии прогрессирующей деформации позвоночника у детей от 16 до 100 % после его первичной хирургической дестабилизации [20]. Продолжающееся накопление продуктов ГАГ в этой области может привести к повторным хирургическим вмешательствам [38].…”

Section: Discussionunclassified

“…Неврологические симптомы (общая слабость, нарушение походки, парапарез, пирамидные симптомы, парестезии, дисфункция ЖКТ и мочевого пузыря, апноэ) развиваются из-за компрессии спинного мозга на уровне краниовертебрального перехода [14][15][16]. Отсутствие лечения стеноза в конечном итоге может привести к тяжелым осложнениям, вплоть до внезапной смерти [6,[17][18][19][20][21]. Таким образом, раннее диагностирование спинального стеноза чрезвычайно важно для предотвращения необра-тимых неврологических проявлений.…”

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Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI

Mironov¹,

Kolesov²,

Переверзев³

et al. 2018

Hir. pozvonoč.

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To analyze surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis. Material and Methods. A total of 9 patients (4 men, 5 women) with mucopolysaccharidosis were operated on for craniovertebral stenosis in 2012–2017. All patients underwent clinical examination, standard radiography of the cervical spine with functional tests to assess atlantooccipital stability according to Rothman, and MRI to determine the degree of the spinal cord compression, stenosis of the spinal canal, and changes in soft tissues surrounding the spinal canal due to fibrosis and accumulation of glycosaminoglycans. Maximum stenosis at the C0–C2 level was noted in 5 patients, at C1–C2 in 2, at C2–C4 in 1, and at C0–C1 in 1. Myelopathy in the upper cervical spine was detected in five cases. The overall somatic and functional statuses, as well as neurological parameters were assessed. Follow-up examination and X-ray examination were performed at 3, 6 and 12 months after surgery, and further every 6 months. Results. The average follow-up period was 2.5 years. The age of the patients varied from 1.8 to 34 years. After 3, 6, and 12 months after surgery, instrumentation was radiologically stable in all cases, there were no bone resorption signs around the elements of instrumentation. Seven patients showed a regression of neurologic symptoms and positive dynamics in the somatic status according to the assessment scales. In one patient, the neurological status remained unchanged. In one case, a temporary deterioration in the condition was noted after a failed intubation attempt, which required emergency tracheostomy, and operation was postponed to a later date to stabilize the condition. Complications after surgical treatment were observed in five patients. In one case, pseudoarthrosis, rod fracture, and instrumentation instability developed 1.5 years after the intervention, and revision surgery was required. Wound healing problems were observed in three patients and a liquorrhea in the early postoperative period, which was stopped without revision intervention – in one case. Conclusion. Decompression and stabilization in patients with mucopolysaccharidosis should be performed in advance, before any neurological disorder development. Fixation is required to prevent the development of instability, post-laminectomy deformities, and progression of cicatricial stenosis. Timely initiation of enzyme-replacement therapy improves the results of mucopolysaccharidosis treatment.

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Section: Discussionunclassified

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Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI

Mironov¹,

Kolesov²,

Переверзев³

et al. 2018

Hir. pozvonoč.

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“…Some reports suggested that laminoplasty resulted in less spinal deformity for the partial restoration of the posterior tension band [4]. But recent studies indicated that the incidence of postoperative spinal deformity associated with laminoplasty is close to laminectomy [8][9][10]. In fact, the study about risk factors for progressive spinal deformity after spinal cord tumors resection using the laminoplasty has been conducted [11].…”

Section: Introductionmentioning

confidence: 99%

Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases

Wang

Chen

et al. 2020

BMC Neurol

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Background: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. Methods: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. Results: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7(2.6%)patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6-114 months). In subsequent multivariate logistic regression analysis, age ≤ 18 years (p = 0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p = 0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94-, 0.69-and 27.11-fold, respectively. Conclusions: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.

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Section: Introductionmentioning

confidence: 99%

Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases

Wang

Chen

et al. 2019

Preprint

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OBJECTIVE: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. METHODS: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. RESULTS: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7（2.6%）patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6–114 months). In subsequent multivariate logistic regression analysis, age≤18 years (p=0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p=0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94- , 0.69- and 27.11-fold, respectively. CONCLUSIONS: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.

show abstract

Instrumented fusion for spinal deformity after laminectomy or laminoplasty for resection of intramedullary spinal cord tumors in pediatric patients

Cited by 37 publications

References 38 publications

Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI

Surgical treatment of craniovertebral stenosis in patients with mucopolysaccharidosis type I, II, and VI

Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases

Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases

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