Surgical correction of pediatric spinal deformities with coexisting intraspinal pathology: A case report and literature review

Abstract

Background: Surgical correction of spinal deformities with coexisting intraspinal pathology (SDCIP) requires special consideration to minimize risks of further injury to an already abnormal spinal cord. However, there is a paucity of literature on this topic. Here, the authors present a pediatric patient with a residual pilocytic astrocytoma and syringomyelia who underwent surgical correction of progressive postlaminectomy kyphoscoliosis. Techniques employed are compared to those in the literature to compile a set of guidelines for surgical correction of SDCIP. Methods: A systematic MEDLINE search was conducted using the following keywords; “pediatric,” “spinal tumor resection,” “deformity correction,” “postlaminectomy,” “scoliosis correction,” “intraspinal pathology,” “tethered cord,” “syringomyelia,” or “diastematomyelia.” Recommendations for surgical technique for pediatric SDCIP correction were reviewed. Results: The presented case demonstrates recommendations that primarily compressive forces on the convexity of the coronal curve should be used when performing in situ correction of SDCIP. Undercorrection is favored to minimize risks of traction on the abnormal spinal cord. The literature yielded 13 articles describing various intraoperative techniques. Notably, seven articles described use of compressive forces on the convex side of the deformity as the primary mode of correction, while only five articles provided recommendations on how to safely and effectively surgically correct SDCIP. Conclusion: The authors demonstrated with their case analysis and literature review that there are no clear current guidelines regarding the safe and effective techniques for in situ correction and fusion for the management of pediatric SDCIP.

Knowledge Review of Spinal Deformity and the Need for Fusion and Fixation following Treatment for Spinal Tumors among the Pediatric Age Group

“…There exists a paucity of surgical guidelines for correcting spinal deformity associated with pediatric spinal tumors – before or after tumor resection. A recent review by Li et al [13] of the MEDLINE database between 1969 and 2019 found only four articles that described approaches and surgical techniques for correction of post-laminectomy deformity after pediatric tumor resection. When their search was broadened to include all intraspinal pathology (including tethered cord, syringomyelia, and diastematomyelia), additional nine articles were found.…”

“…Decompression of neural elements and resection of oncologic pathology, where possible, should precede manipulation of the spine and correction of deformity. Li et al [13] further recommend avoiding distractive maneuvers in favor of compressive maneuvers to avoid overlengthening of the canal and stretching of the spinal cord in the setting of intraspinal masses.…”

Multiple three-column osteotomies successfully correcting cervicothoracic kyphosis in the setting of ankylosing spondylitis: illustrative case

“… 3 , 4 There is, however, no current guideline for surgical correction. 5 In cases of extreme kyphoscoliosis (>60° in the sagittal plane), double pedicle subtraction osteotomy (PSO) conducted at the lower thoracic and L2–3 vertebrae has been found to be effective in correcting spine misalignment. 6 , 7 Unfortunately, PSO requires a longer operative time than lower-grade osteotomies, carrying greater associated blood loss and risk of neurological injury.…”