Department of Neurosurgery, University of Maryland School of Medicine.
Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
Neurosurg Focus. 2017 Oct;43(4):E12. doi: 10.3171/2017.7.FOCUS17329.
OBJECTIVE Spinal deformity has become a well-recognized complication of intramedullary spinal cord tumor (IMSCT) resection. In particular, laminectomy can result in biomechanical instability caused by loss of the posterior tension band. Therefore, laminoplasty has been proposed as an alternative to laminectomy. Here, the authors describe the largest current series of pediatric patients who have undergone laminoplasty for IMSCT resection and investigate the need for surgical fusion after both laminectomy and laminoplasty. METHODS The medical records of pediatric patients who underwent resection of an IMSCT at a single institution between November 2003 and May 2014 were reviewed retrospectively. Demographic, clinical, radiological, surgical, histopathological, and follow-up data were collected. RESULTS Sixty-six consecutive patients underwent resection of an IMSCT during the study period. Forty-three (65%) patients were male. The patients had a median age of 12.9 years (interquartile range [IQR] 7.2-16.5 years) at the time of surgery. Patients typically presented with a tumor that involved the cervical and/or thoracic spine. Nineteen (29%) patients underwent laminectomy, and 47 (71%) patients underwent laminoplasty. Patients in each cohort had a similar rate of postoperative deformity. Overall, 10 (15%) patients required instrumented spinal fusion for spinal deformity. Four patients required revision of the primary fusion. CONCLUSIONS These findings show that among pediatric patients with an IMSCT, postoperative surgical fusion rates remain high, even after laminoplasty. Known risk factors, such as the age of the patient, location of the tumor, and the number of involved levels, might play a larger role than replacement of the laminae in determining the rate of surgical fusion after IMSCT resection.
目的
脊髓内肿瘤(IMSCT)切除术后脊柱畸形已成为一种公认的并发症。特别是椎板切除术可导致由于后张力带丧失而引起的生物力学不稳定。因此,已提出椎板成形术作为椎板切除术的替代方法。在此,作者描述了目前最大的一组接受椎板成形术治疗 IMSCT 切除的儿科患者,并研究了在椎板切除术和椎板成形术后均需要手术融合的情况。
方法
回顾性分析 2003 年 11 月至 2014 年 5 月期间在一家医疗机构接受 IMSCT 切除术的儿科患者的病历。收集了人口统计学、临床、影像学、手术、组织病理学和随访数据。
结果
研究期间,66 例连续患者接受了 IMSCT 切除术。43 例(65%)患者为男性。患者手术时的中位年龄为 12.9 岁(四分位距[IQR] 7.2-16.5 岁)。患者通常表现为颈椎和/或胸椎受累的肿瘤。19 例(29%)患者行椎板切除术,47 例(71%)患者行椎板成形术。每个队列的患者术后畸形发生率相似。总体而言,10 例(15%)患者因脊柱畸形需要行器械性脊柱融合术。4 例患者需要对原发性融合进行翻修。
结论
这些发现表明,在患有 IMSCT 的儿科患者中,即使在接受椎板成形术后,术后手术融合率仍然很高。已知的危险因素,如患者年龄、肿瘤位置和受累节段数,可能比替换椎板在决定 IMSCT 切除术后手术融合率方面发挥更大的作用。