Background: Benign intradural extramedullary (IDEM) tumours in children are usually neural sheath derivatives or are dura based. Total resection of these benign tumours is the primary surgical goal. A management issue related to their occurrence in the growing paediatric spine is a higher propensity for the development of postlaminectomy kyphosis, especially in the upper cervical spine, than what is seen in adults. Methods: A retrospective study was performed on 22 patients to analyse the incidence, presentation and management of postoperative kyphotic deformities in children who underwent laminotomy and tumour excision for benign cervical IDEM tumours. Results: The incidence of postoperative kyphosis was 13%. All these patients underwent subsequent posterior fusion following reduction of the deformity with good results. Conclusion: Following excision of cervical intradural lesions, paediatric patients need to be followed up regularly to rule out the development of postsurgical deformities especially in the upper cervical spine region. Various biomechanical, surgical and tumour-related factors which influence the development of deformities are reviewed.

Keywords:
Cervical fusion, Cervical spine, Intradural spinal tumour, Kyphosis, Myelopathy, paediatric
1.
McGirt MJ, Garcés-Ambrossi GL, Parker SL, Sciubba DM, Bydon A, Wolinksy JP, Gokaslan ZL, Jallo G, Witham TF: Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients. Neurosurgery 2010;66:1005–1012.
2.
Sciubba DM, Chaichana KL, Woodworth GF, McGirt MJ, Gokaslan ZL, Jallo GI: Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine 2008;8:413–419.
3.
De Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illés T: Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours. Eur Spine J 2005;14:765–771.
4.
McGirt MJ, Chaichana KL, Attenello F, Witham T, Bydon A, Yao KC, Jallo GI: Spinal deformity after resection of cervical intramedullary spinal cord tumors in children. Childs Nerv Syst 2008;24:735–739.
5.
Casha S, Engelbrecht HA, Du Plessis SJ, Hurlbert RJ: Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages, and complications. J Neurosurg Spine 2004;1:80–86.
6.
Shiraishi T: Skip laminectomy – a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. Spine J 2002;2:108–115.
7.
Fassett DR, Clark R, Brockmeyer DL, Schmidt MH: Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus 2006;20:E2.
8.
Ghanem I, El Hage S, Rachkidi R, Kharrat K, Dagher F, Kreichati G: Pediatric cervical spine instability. J Child Orthop 2008;2:71–84.
9.
Yasuoka S, Peterson HA, MacCarty CS: Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 1982;57:441–445.
10.
Goel VK, Clark CR, Harris KG, Schulte KR: Kinematics of the cervical spine: effects of multiple total laminectomy and facet wiring. J Orthop Res 1988;6:611–619.
11.
Takeshita K, Peterson ET, Bylski-Austrow D, Crawford AH, Nakamura K: The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976) 2004;29:E388–E393.
12.
Nakanishi K, Taneda M, Sumii T, Yabuuchi T, Iwakura N: Cervical myelopathy caused by dropped head syndrome: case report and review of the literature. J Neurosurg Spine 2007;6:165–168.
13.
Ratliff JK, Cooper PR: Cervical laminoplasty: a critical review. J Neurosurg 2003;98(suppl 3):230–238.
14.
Sonntag VK, Hadley MN: Nonoperative management of cervical spine injuries. Clin Neurosurg 1988;34:630–649.
15.
White AA 3rd, Panjabi MM: The basic kinematics of the human spine: a review of past and current knowledge. Spine (Phila Pa 1976) 1978;3:12–20.
16.
Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L: Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000;93(suppl 2):199–204.
17.
Lunardi P, Licastro G, Missori P, Ferrante L, Fortuna A: Management of intramedullary tumors in children. Acta Neurochir (Wien) 1993;120:59–65.
18.
Katsumi Y, Honma T, Nakamura T: Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine 1989;14:1171–1176.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.