Abstract
Study design
Retrospective chart audit.
Objectives
This study investigated changes in sagittal alignment in adults after excision of thoracic spinal cord tumors without spinal fixation.
Setting
Single-center study at an academic orthopedic department in Japan.
Methods
We retrospectively reviewed records for 32 adults who underwent excision of thoracic spinal cord tumors by multilevel laminectomies without fixation. The participants were divided according to whether the tumor was in the upper (T1–4), middle (T5–8), or lower (T9–12) thoracic spine. We analyzed parameters such as age, sex, time in surgery and estimated blood loss, follow-up period, and preoperative and follow-up the Japanese Orthopaedic Association (JOA) scores and radiographs.
Results
Postoperative T1-12 kyphotic changes did not correlate with age, the number of resected laminae, or preoperative T1-12 kyphosis. JOA recovery rates were similar regardless of the tumor location. Participants with tumors in the upper thoracic spine had significant postoperative increases in T1–4 kyphosis, T1 slope (p < .05, respectively). In contrast, there were no significant changes in alignment in participants with tumors in the middle or lower thoracic spine.
Conclusion
Even without fixation, sagittal alignment did not change after surgery to excise tumors in the middle and lower thoracic spine, indicating that fixation may not be necessary when excising spinal cord tumors in this region. In contrast, postoperative kyphosis may increase when the tumor is in the upper thoracic spine.
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References
Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, et al. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine. 2007;7:13–20.
Herkowitz HN. A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy. Spine. 1988;13:774–80.
Fong SY, Wong HK. Thoracic myelopathy secondary to ligamentum flavum ossification. Ann Acad Med Singap. 2004;33:340–6.
Mikawa Y, Shikata J, Yamamuro T. Spinal deformity and instability after multilevel cervical laminectomy. Spine. 1987;12:6–11.
Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg. 1982;57:441–5.
Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM. Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine. 1997;22:442–51.
Yao KC, McGirt MJ, Chaichana KL, Constantini S, Jallo GI. Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children: an analysis of 161 consecutive cases. J Neurosurg. 2007;107:463–8.
Joaquim AF, Cheng I, Patel AA. Postoperative spinal deformity after treatment of intracanal spine lesions. Spine J. 2012;12:1067–74.
Aizawa T, Sato T, Ozawa H, Morozumi N, Matsumoto F, Sasaki H, et al. Sagittal alignment changes after thoracic laminectomy in adults. J Neurosurg Spine. 2008;8:510–6.
Lonstein JE. Post-laminectomy kyphosis. Clin Orthop Relat Res. 1977;128:93–100.
Miyazaki K, Kirita Y. Extensive simultaneous multisegment laminectomy for myelopathy due to the ossification of the posterior longitudinal ligament in the cervical region. Spine. 1986;11:531–42.
Fehlings MG, Chua SY. Editorial: spinal cord tumor research. J Neurosurg Spine. 2010;12:115–6.
Bowers DC, Weprin BE. Intramedullary spinal cord tumors. Curr Treat Options Neurol. 2003;5:207–12.
Wiggins GC, Shaffrey CI. Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery. 2007;60:S71–81.
Simon SL, Auerbach JD, Garg S, Sutton LN, Telfeian AE, Dormans JP. Efficacy of spinal instrumentation and fusion in the prevention of postlaminectomy spinal deformity in children with intramedullary spinal cord tumors. J Pediatr Orthop. 2008;28:244–9.
Anakwenze OA, Auerbach JD, Buck DW, Garg S, Simon SL, Sutton LN, et al. The role of concurrent fusion to prevent spinal deformity after intramedullary spinal cord tumor excision in children. J Pediatr Orthop. 2011;31:475–9.
Landmann C, Hunig R, Gratzl O. The role of laminectomy in the combined treatment of metastatic spinal cord compression. Int J Radiat Oncol Biol Phys. 1992;24:627–31.
Cummings RJ. Recurrent meningitis secondary to infection after spinal arthrodesis with instrumentation. A case report. J Bone Jt Surg Am. 1998;80:722–4.
Warren DT, Ricart-Hoffiz PA, Andres TM, Hoelscher CM, Protopsaltis TS, Goldstein JA, et al. Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy. Int J Spine Surg. 2013;7:e72–80.
Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine. 1994;19:1611–8.
Duval-Beaupere G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20:451–62.
Kimura I, Shingu H, Nasu Y. Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Jt Surg Br. 1995;77:956–61.
Yeh JS, Sgouros S, Walsh AR, Hockley AD. Spinal sagittal malalignment following surgery for primary intramedullary tumours in children. Pediatr Neurosurg. 2001;35:318–24.
Wang VY, Chou D. The cervicothoracic junction. Neurosurg Clin N Am. 2007;18:365–71.
Steinmetz MP, Miller J, Warbel A, Krishnaney AA, Bingaman W, Benzel EC. Regional instability following cervicothoracic junction surgery. J Neurosurg Spine. 2006;4:278–84.
An HS, Vaccaro A, Cotler JM, Lin S. Spinal disorders at the cervicothoracic junction. Spine. 1994;19:2557–64.
Avila MJ, Walter CM, Skoch J, Abbasifard S, Patel AS, Sattarov K, et al. Fusion after intradural spine tumor resection in adults: A review of evidence and practices. Clin Neurol Neurosurg. 2015;138:169–73.
Watanabe K, Matsumoto M, Ikegami T, Nishiwaki Y, Tsuji T, Ishii K, et al. Reduced postoperative wound pain after lumbar spinous process-splitting laminectomy for lumbar canal stenosis: a randomized controlled study. J Neurosurg Spine. 2011;14:51–8.
Shiraishi T, Kato M, Yato Y, Ueda S, Aoyama R, Yamane J, et al. New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application. Spine. 2012;37:E286–96.
Millward CP, Bhagawati D, Chan HW, Bestwick J, Brecknell JE. Retrospective observational comparative study of Hemilaminectomy versus Laminectomy for intraspinal tumour resection; shorter stays, lower analgesic usage and less kyphotic deformity. Br J Neurosurg. 2015;29:390–5.
Acknowledgements
We are grateful to the individuals who participated in this study. We also thank Dr. Takahiro Tadokoro for advice on statistical analyses.
Author contributions:
YK collected, and interpreted the data and wrote the initial draft of the manuscript. SK and YN collected data. OT, EO, NF, MY, KW assisted in the preparation of the manuscript. MM, MN, NN designed the study, and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.
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Kobayashi, Y., Kawabata, S., Nishiyama, Y. et al. Changes in sagittal alignment after surgical excision of thoracic spinal cord tumors in adults. Spinal Cord 57, 380–387 (2019). https://doi.org/10.1038/s41393-018-0235-3
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DOI: https://doi.org/10.1038/s41393-018-0235-3