SPINAL COLUMN DEFORMITY AND INSTABILITY AFTER LUMBAR OR THORACOLUMBARLAMINECTOMY FOR INTRASPINAL TUMORS IN CHILDREN AND YOUNG-ADULTS

Study Design. A retrospective study about the occurrence of spinal col umn deformity or instability after multilevel lumbar or thoracolumbar total laminectomy for removal of benign intraspinal tumors in children and young adults. Objectives. To analyze the long-term clinical and r adiographic outcome of these patients, and to specify factors that aff ect the occurrence of postlaminectomy spinal column deformity and inst ability. Summary of Background Data. Spinal column deformity is not un common after multilevel cervical or thoracic laminectomies for removal of intraspinal tumors in children, its incidence in the lumbar and th oracolumbar spine reportedly is low. Methods. Thirty-six consecutive p atients (23 male, 13 female) underwent multilevel lumbar or thoracolum bar total laminectomy for removal of benign intraspinal tumors from 19 66 to 1989. Twelve patients were aged 17 years or younger (''children and adolescents''; mean age, 11 years), and 24 were aged 18-30 years ( ''young adults''; mean age, 24 years). All patients had preoperative, immediate postoperative, and follow-up clinical and radiographic exami nations. Results. At a mean follow-up period of 14 years (range, 4-28 years), six patients (16.6%) had spinal deformity (lordosis or thoraco lumbar kyphosis associated with scoliosis), and four (11%) had spondyl olisthesis, Spinal column deformity occurred in 33% of children and ad olescents and in 8% of young adults. Spondylolisthesis occurred in 16. 6% of children and adolescents and in 8% of young adults. Three patien ts had fur sign for spinal column deformity. Pain was present in eight patients, and other neurologic signs and symptoms were found in 18. T here was an increased incidence of postoperative spinal deformity in p atients who had more than two laminae removed (P<0.01) or a facetectom y performed at the time of the initial operation (P<0.05). There was n ot association between the occurrence of the deformity and sex, neurol ogic condition after laminectomy, or length of follow-up period. Concl usions. Spinal deformity or instability after multilevel lumbar or tho racolumbar total laminectomy is not uncommon in children and adolescen ts. Limiting laminae removal and facet destruction may decrease this i ncidence. Fusion may be required to correct post-laminectomy deformity and to stabilize the spine.