Papagelopoulos P J, Peterson H A, Ebersold M J, Emmanuel P R, Choudhury S N, Quast L M
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA.
Spine (Phila Pa 1976). 1997 Feb 15;22(4):442-51. doi: 10.1097/00007632-199702150-00019.
A retrospective study about the occurrence of spinal column deformity or instability after multilevel lumbar or thoracolumbar total laminectomy for removal of benign intraspinal tumors in children and young adults.
To analyze the long-term clinical and radiographic outcome of these patients, and to specify factors that affect the occurrence of postlaminectomy spinal column deformity and instability.
Spinal column deformity is not uncommon after multilevel cervical or thoracic laminectomies for removal of intraspinal tumors in children. Its incidence in the lumbar and thoracolumbar spine reportedly is low.
Thirty-six consecutive patients (23 male, 13 female) underwent multilevel lumbar or thoracolumbar total laminectomy for removal of benign intraspinal tumors from 1966 to 1989. Twelve patients were aged 17 years or younger ("children and adolescents"; mean age, 11 years), and 24 were aged 18-30 years ("young adults"; mean age, 24 years). All patients had preoperative, immediate postoperative, and follow-up clinical and radiographic examinations.
At a mean follow-up period of 14 years (range, 4-28 years), six patients (16.6%) had spinal deformity (lordosis or thoracolumbar kyphosis associated with scoliosis), and four (11%) had spondylolisthesis. Spinal column deformity occurred in 33% of children and adolescents and in 8% of young adults. Spondylolisthesis occurred in 16.6% of children and adolescents and in 8% of young adults. Three patients had fusion for spinal column deformity. Pain was present in eight patients, and other neurologic signs and symptoms were found in 18. There was an increased incidence of postoperative spinal deformity in patients who had more than two laminae removed (P < 0.01) or a facetectomy performed at the time of the initial operation (P < 0.05). There was no association between the occurrence of the deformity and sex, neurologic condition after laminectomy, or length of follow-up period.
Spinal deformity or instability after multilevel lumbar or thoracolumbar total laminectomy is not uncommon in children and adolescents. Limiting laminae removal and facet destruction may decrease this incidence. Fusion may be required to correct post-laminectomy deformity and to stabilize the spine.
一项关于儿童和青年行多节段腰椎或胸腰段全椎板切除术以切除椎管内良性肿瘤后脊柱畸形或不稳定发生率的回顾性研究。
分析这些患者的长期临床和影像学结果，并明确影响椎板切除术后脊柱畸形和不稳定发生的因素。
儿童行多节段颈椎或胸椎椎板切除术以切除椎管内肿瘤后，脊柱畸形并不少见。据报道，其在腰椎和胸腰段脊柱的发生率较低。
1966年至1989年，36例连续患者（男23例，女13例）接受了多节段腰椎或胸腰段全椎板切除术以切除椎管内良性肿瘤。12例患者年龄在17岁及以下（“儿童和青少年”；平均年龄11岁），24例年龄在18 - 30岁（“青年”；平均年龄24岁）。所有患者均进行了术前、术后即刻及随访时的临床和影像学检查。
平均随访14年（范围4 - 28年），6例患者（16.6%）出现脊柱畸形（脊柱前凸或合并脊柱侧凸的胸腰段后凸），4例（11%）出现椎体滑脱。脊柱畸形在儿童和青少年中发生率为33%，在青年中为8%。椎体滑脱在儿童和青少年中发生率为16.6%，在青年中为8%。3例患者因脊柱畸形接受了融合手术。8例患者有疼痛，18例有其他神经体征和症状。切除超过两个椎板（P < 0.01）或初次手术时行小关节突切除术（P < 0.05）的患者术后脊柱畸形发生率增加。畸形的发生与性别、椎板切除术后神经状况或随访时间长短无关。
儿童和青少年行多节段腰椎或胸腰段全椎板切除术后脊柱畸形或不稳定并不少见。限制椎板切除和小关节突破坏可能会降低这一发生率。可能需要进行融合手术以纠正椎板切除术后畸形并稳定脊柱。
