Orthopaedic implications in the management of pediatric vertebral and spinal cord tumors: a retrospective review.

Abstract

Retrospective review of pediatric patients with vertebral and spinal cord tumors. To identify clinical and radiographic features of diagnostic importance, and to evaluate the effectiveness of surgical treatment with respect to complications in pediatric patients with vertebral and spinal cord tumors. Vertebral and spinal cord tumors in children are uncommon and present a significant challenge in diagnosis, treatment, and management of complications. Because most signs and symptoms of these tumors are musculoskeletal in nature, it is imperative for orthopedic surgeons to be familiar with them. Medical charts and radiographic records of 26 pediatric patients with documented vertebral and spinal cord tumors were reviewed retrospectively. There were 10 malignant and 16 benign tumors. Mean age at diagnosis was 10 years, and the male-to-female ratio was 1:1. Mean clinical follow-up was 25.8 months. The average delay in diagnosis was 10.9 months. The two most common reasons for presentation were pain (n = 20, 76%) and neurologic involvement (n = 14, 54%). Initial plain radiographs were positive in 72% of patients, whereas MRI showed the tumor in 96% of studies. Sixteen patients underwent spinal fusion after excision of the tumor. There were no perioperative deaths. Complications were common, with an average of 1.1 complications per patient. At latest follow-up, six patients had neurologic deficits, two patients had died, and one patient was terminally ill. Increased awareness of modes of presentation, use of modern imaging techniques, and an aggressive approach to spinal stabilization at the time of laminectomy should decrease morbidity in patients with vertebral and spinal cord tumors.