Spinal deformity following surgery for paediatric intramedullary spinal cord tumours.

objectiveSpinal deformity (SD) in children with intramedullary spinal cord tumours (IMSCT) can occur at presentation or postoperatively due to neurogenic and mechanical factors on a background of future spinal growth. Deformity is associated with pain, functional decline and reduced quality of life but spinal instrumentation can compromise MRI tumour surveillance. This study aims to identify risk factors for SD amongst children operated for low-grade IMSCT to identify any modifiable risk factors and help guide pre-operative counselling and surveillance.

methodsCases of benign IMSCT in patients under 16 were identified from a prospectively collected institutional operative database. Review of electronic medical records was then undertaken for details of presenting symptoms, SD at diagnosis, histology, surgical approach (laminectomy/laminoplasty). High grade tumours and previously operated tumours were excluded. Outcome measures comprised spinal alignment at last follow-up and any additional interventions (bracing or surgery) to address deformity. Data was analysed using Excel and SPSS.

results45 patients satisfied the inclusion criteria. Mean age at index surgery was 7.1 years, and at last follow up 13.8 years. At presentation, 38% had SD (N = 17/45), 11% torticollis (n = 5/45), 64% pain (n = 30/45) and 43% weakness (n = 19/45). Tumour location was thoracic (40%, n = 18/45)), cervicothoracic (33%, n = 14/45) and cervical (27%, n = 12/45). Tumour histology included low-grade astrocytoma (66%, n = 30/45), glioneuronal tumour (13%, n = 6/45), ependymoma (7%, n = 3/45), cavernoma (4%, n = 2/45), haemangioblastoma (2%, n = 2/45) and neuroenteric cyst (2%, n = 1/45), Laminoplasty was performed in all cases, 51% (n = 23/45) crossing a junctional level. Postoperative MRI confirmed total resection in 51% (n = 23/45). 43% received adjuvant therapy (n = 19/45). 85% (n = 38/45) wore a post-operative spinal orthosis for mean duration 5.27 months (range 1.5-36 months). Postoperative SD occurred in 69% (n = 31/45) of which 48% (n = 15/31) developed following surgery, typically within 2.6 years of follow up. 42% required further bracing (n = 19/45) and 31% underwent spinal fusion (n = 14/45) at an average of 5.5 years post-resection. Patients presenting with SD were significantly more likely to require spinal fusion (p =  < 0.01). Thoracic location and the presence of a syrinx were also risk factors for progressive SD.

conclusionsSD is common in children with low-grade IMSCT in children affecting one third at presentation and two thirds post-operatively with one third requiring spinal fusion for deformity correction. Risk factors include: SD at presentation, thoracic cord location and presence of syrinx.