Medical Student Department of Neurosurgery, University of Oklahoma Health Sciences Center
Introduction: Kyphosis is a well-documented sequela of intradural spinal tumor resection (IDTR), with up to 50% of pediatric patients going on to develop post-resection kyphosis. Theoretically, laminoplasty, rather than laminectomy, combats this complication by preserving the integrity of the posterior column. Several comparative studies and systematic reviews have compared the incidence of post-resection kyphosis between these two techniques in adult patients. However, to the author’s knowledge, a systematic review has yet to be performed in the pediatric population.
Methods: A systematic review was conducted following PRISMA guidelines within the PubMed, Embase, and MEDLINE databases. Original publications describing pediatric patients ( < 18 years) undergoing IDTR were included. Clinical characteristics, procedure details, and structural and clinical outcomes were analyzed.
Results: The review included 33 studies and was comprised of 281 patients: 178 (63.3%) undergoing laminectomy and 103 (36.7%) undergoing laminoplasty. 33 (18.5%) of the patients undergoing laminectomy received concomitant fusion. The most common pathologies were astrocytoma (50.3%), ependymoma (18.4%), and arachnoid cyst (9.2%). Post-resection kyphosis was observed in 84 (47.2%) of the laminectomy patients versus 55 (53.4%) of the laminoplasty patients (p=0.24). More specifically, when compared to laminoplasty, neither laminectomy alone (57.4%) (p=0.72) nor laminectomy with concomitant fusion (66.7%) (p=0.49) demonstrated significant differences in post-operative kyphosis. There was no significant difference when comparing laminectomy alone versus laminectomy with fusion (p=0.66). Among laminoplasties, the cervical region exhibited the highest propensity for post-resection kyphosis (60%). Regarding laminectomies, those spanning the thoracolumbar region demonstrated the highest incidence of kyphosis (75%).
Conclusion : Pediatric patients undergoing IDTR experienced similar rates of post-resection kyphosis regardless of whether laminectomy alone, laminectomy with fusion, or laminoplasty was utilized. Mobile and transitional spinal segments posed increased risk for kyphosis irrespective of technique. Further comparative data is needed to elucidate the relationship between laminectomy versus laminoplasty and iatrogenic kyphosis in children.