Ghanem I, Zeller R, Dubousset J
Université René Descartes (Paris V), Service de Chirurgie Orthopédique Infantile, Hôpital Saint-Vincent-de-Paul.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(4):313-20.
The delay in diagnosis of spinal tumors is not rare. The chief complaint may include pain, walking disability, and spinal or limb deformities. The purpose of our study is to analyze the spinal deformities associated with non osseous intraspinal tumors, to assess the complications of treatment, and to set out a preventive protocol.
We reviewed retrospectively 40 consecutive cases of non osseous intraspinal tumors treated between 1972 and 1991. There were 32 intradural, 2 extradural, and 6 intra and extradural combined tumors. At the first consultation, the age ranged between 4 months and 15 years, and only 16 patients showed neurologic deficit. Spinal deformity existed in 9 patients, 7 of which had no neurologic deficit. All the tumors were treated surgically. Laminectomy was done in 28 cases, and osteoplastic laminotomy in 12 cases. The number of levels included in the laminectomy ranged from 3 to 18. Bilateral arthrectomy at least at one level was undertaken in 15 cases. A postoperative brace was worn in all cases for an average period of 4 months. An adjuvant radiotherapy was undertaken in 12 cases for an incomplete resection.
The incidence and pattern of spinal deformity was assessed before tumor treatment and ultimately after laminectomy or osteoplastic laminotomy (or laminoplasty).
Among the 9 cases with preexisting spinal deformity, the curve magnitude increased after laminectomy in 4. A kyphotic, kyphosoliotic or scoliotic deformity developed in 18 cases after surgery for tumor resection. Among these 18 patients, only one had had an adequate osteoplastic laminotomy. The treatment of spinal deformities was surgical in 12 cases, and done by either posterior or anterior and posterior combined arthrodesis.
Spinal deformity may be the main complaint of a patient who has intraspinal tumor. Prevention of postlaminectomy spinal deformity is mandatory, and could be done by osteoplastic laminotomy and the use of a brace during a minimum period of 4 to 6 months after surgery.
Diagnosis of intraspinal tumors in children and adolescents should be done early, and laminoarthrectomy should be replaced by osteoplastic laminotomy.
脊柱肿瘤诊断延迟并不罕见。主要症状可能包括疼痛、行走障碍以及脊柱或肢体畸形。本研究的目的是分析与非骨性椎管内肿瘤相关的脊柱畸形，评估治疗并发症，并制定预防方案。
我们回顾性分析了1972年至1991年间连续治疗的40例非骨性椎管内肿瘤病例。其中硬脊膜内肿瘤32例，硬脊膜外肿瘤2例，硬脊膜内外联合肿瘤6例。初诊时，年龄在4个月至15岁之间，仅有16例患者存在神经功能缺损。9例患者存在脊柱畸形，其中7例无神经功能缺损。所有肿瘤均接受手术治疗。28例行椎板切除术，12例行整复性椎板切开术。椎板切除术涉及的节段数为3至18个。15例行至少一个节段的双侧关节突切除术。所有病例术后均佩戴支具，平均佩戴时间为4个月。12例因切除不完全而接受辅助放疗。
在肿瘤治疗前以及最终在椎板切除术或整复性椎板切开术（或椎板成形术）后评估脊柱畸形的发生率和类型。
在9例术前存在脊柱畸形的病例中，4例在椎板切除术后侧弯程度增加。18例在肿瘤切除术后出现后凸、后凸侧凸或侧凸畸形。在这18例患者中，仅有1例行充分的整复性椎板切开术。12例脊柱畸形患者接受了手术治疗，采用后路或前后联合关节融合术。
脊柱畸形可能是椎管内肿瘤患者的主要症状。必须预防椎板切除术后脊柱畸形，可通过整复性椎板切开术以及术后至少4至6个月佩戴支具来实现。
儿童和青少年椎管内肿瘤应早期诊断，椎板关节突切除术应被整复性椎板切开术取代。
