224 - Is it Valuable to Perform Posterior Fixation after Cervical Laminectom...

#224 Is it Valuable to Perform Posterior Fixation after Cervical Laminectomy in Younger Aged Patients? A Case Report of Severe Cervical Kyphosis after Laminectomy for Tumor Removal

Cervical Therapies and Outcomes

Poster Presented by: H. Tsou

Author(s):

H.-K. Tsou (1)
S.-Y. Chen (1)
T.-H. Kao (1)

(1) Taichung Veterans General Hospital, Department of Neurosurgery, Taichung, Taiwan, Republic of China

Abstract

Purpose: Fusion surgery remains controversial in the pediatric age group. We present a case report on a child who received cervical laminectomy for a spinal tumor and developed severe kyphosis less than 1 year after.

Results: An 11 year-old boy suffered from severe neck pain with soreness and numbness of left shoulder for half a year. A C3-4 intraspinal extramedullary neurilemmoma, located in ventral part of C2-4 spinal canal and extension to left C4 root was diagnosed (Fig.1). A C2 left hemilaminectomy and C3-4 laminectomies were performed to remove the intraspinal tumor. Considering the patient's young age, we did not perform posterior fixation immediately in the same operation, but provided the patient with neck collar support instead. Further radiosurgery using a cyber-knife was performed on the residual tumor at the left C4 root due to vertebral artery encasement. His myeloradiculopathy symptoms diminished after that operation. The follow-up cervical magnetic resonance image showed stable tumor growth, but mild kyphosis at the 3rd month. The patient was found symptom free at the follow-up examination. In the 9th post-operation month, the patient presented left arm weakness and numbness. The cervical image showed severe kyphosis with severe cord compression . Anterior cervical discectomy and fusion and plate fixation were performed. The cervical curvature was corrected and the symptoms were relieved after the second operation (Fig. 2). The patient presented stable cervical alignment in the following 4 years.

Conclusion: Literature on post-laminectomy in the pediatric age group remains limited. The activity and growth characteristics make us think differently with younger patient age groups. We suggest that it may be necessary to perform posterior fixation with instrumentation after long-segment laminectomies in children.

Fig. 1 A C3-4 intraspinal extramedullary neurilemm

Fig. 2 Anterior cervical discectomy and fusion and