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Open Access 01-11-2020 | Laminectomy | Original Article - Spine - Other

Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study

Authors: Charles Tatter, Alexander Fletcher-Sandersjöö, Oscar Persson, Gustav Burström, Per Grane, Erik Edström, Adrian Elmi-Terander

Published in: Acta Neurochirurgica | Issue 11/2020

Abstract

Background

The first line of treatment for most cervical intradural tumors is surgical resection through laminotomy or laminectomy. This may cause a loss of posterior pulling force leading to kyphosis, which is associated with decreased functional outcome. However, the incidence and predictors of kyphosis in these patients are poorly understood.

Object

To assess the incidence of posterior fixation (PF), as well as predictors of radiological kyphosis, following resection of cervical intradural tumors in adults.

Methods

A population-based cohort study was conducted on adult patients who underwent intradural tumor resection via cervical laminectomy with or without laminoplasty between 2005 and 2017. Primary outcome was kyphosis requiring PF. Secondary outcome was radiological kyphotic increase, measured by the change in the C2–C7 Cobb angle between pre- and postoperative magnetic resonance images.

Results

Eighty-four patients were included. Twenty-four percent of the tumors were intramedullary, and the most common diagnosis was meningioma. The mean laminectomy range was 2.4 levels, and laminoplasty was performed in 40% of cases. No prophylactic PF was performed. During a mean follow-up of 4.4 years, two patients (2.4%) required delayed PF. The mean radiological kyphotic increase after surgery was 3.0°, which was significantly associated with laminectomy of C2 and C3. Of these, C3 laminectomy demonstrated independent risk association.

Conclusions

There was a low incidence of delayed PF following cervical intradural tumor resection, supporting the practice of not performing prophylactic PF. Kyphotic increase was associated with C2 and C3 laminectomy, which could help identify at-risk patients were targeted follow-up is indicated.

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Duong LM, McCarthy BJ, McLendon RE, Dolecek TA, Kruchko C, Douglas LL, Ajani UA (2012) Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004–2007. Cancer 118(17):4220–4227CrossRef

Persson O, Fletcher-Sandersjöö A, Burström G, Edström E, Elmi-Terander A (2019) Surgical treatment of intra- and juxtamedullary spinal cord tumors: a population based observational cohort study. Front Neurol 10:814CrossRef

Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI (2015) Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus 39(2):E14CrossRef

Krishnan Kutty R, Sreemathyamma SB, Sivanandapanicker JL, Asher P, Prabhakar RB, Peethambaran A Hemilaminectomy for spinal cord intradural tumors: an institutional experience. Asian J Neurosurg 13(3):760–765

McGirt MJ, Garcés-Ambrossi GL, Parker SL, Sciubba DM, Bydon A, Wolinksy J-P, Gokaslan ZL, Jallo G, Witham TF (2010) Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients. Neurosurgery 66(5):1005–1012CrossRef

Pal GP, Sherk HH (1988) The vertical stability of the cervical spine. Spine (Phila Pa 1976) 13(5):447–449CrossRef

Kode S, Kallemeyn NA, Smucker JD, Fredericks DC, Grosland NM (2014) The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study. Iowa Orthop J 34:150–157PubMedPubMedCentral

Yoganandan N, Kumaresan S, Pintar FA (2001) Biomechanics of the cervical spine. Part 2. Cervical spine soft tissue responses and biomechanical modeling. Clin Biomech 16(1):1–27CrossRef

Asazuma T, Nakamura M, Matsumoto M, Chibo K, Toyama Y (2004) Postoperative changes of spinal curvature and range of motion in adult patients with cervical spinal cord tumors: analysis of 51 cases and review of the literature. J Spinal Disord Tech 17(3):178–182CrossRef

10.

Albert TJ, Vacarro A (1998) Postlaminectomy kyphosis. Spine (Phila Pa 1976) 23(24):2738–2745CrossRef

11.

Scheer JK, Tang JA, Smith JS et al (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19(2):141–159CrossRef

12.

Fassett DR, Clark R, Brockmeyer DL, Schmidt MH (2006) Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus. https://doi.org/10.3171/foc.2006.20.2.3

13.

McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI (2008) Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr 1(1):57–62CrossRef

14.

Sciubba DM, Chaichana KL, Woodworth GF, McGirt MJ, Gokaslan ZL, Jallo GI (2008) Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine 8(5):413–419CrossRef

15.

Guo G-M, Li J, Diao Q-X, Zhu T-H, Song Z-X, Guo Y-Y, Gao Y-Z (2018) Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res 13(1):147CrossRef

16.

Katsumi Y, Honma T, Nakamura T (1989) Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine (Phila Pa 1976) 14(11):1171–1176CrossRef

17.

Inoue A, Ikata T, Katoh S (1996) Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord 34(9):536–542CrossRef

18.

Nori S, Iwanami A, Yasuda A, et al (2017) Risk factor analysis of kyphotic malalignment after cervical intramedullary tumor resection in adults. J. Neurosurg. Spine. American Association of Neurological Surgeons, pp 518–527

19.

Saito T, Yamamuro T, Shikata J, Oka M, Sutsumi S (1991) Analysis and prevention of spinal column deformity following cervical laminectomy I: pathogenetic analysis of postiaminectomy deformities. Spine (Phila Pa 1976) 16(5):494–502CrossRef

20.

Nolan JP, Sherk HH (1988) Biomechanical evaluation of the extensor musculature of the cervical spine. Spine (Phila Pa 1976) 13(1):9–11CrossRef

21.

Shiraishi T, Yato Y (2002) New double-door laminoplasty procedure for the axis to preserve all muscular attachments to the spinous process: technical note. Neurosurg Focus. https://doi.org/10.3171/foc.2002.12.1.10

22.

Vasavada AN, Li S, Delp SL (1998) Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles. Spine (Phila Pa 1976) 23(4):412–422CrossRef

23.

Takeuchi K, Yokoyama T, Ono A, Numasawa T, Wada K, Kumagai G, Ito J, Ueyama K, Toh S (2007) Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech 20(8):571–576CrossRef

24.

Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98(3 SUPPL):230–238PubMed

25.

Passias PG, Vasquez-Montes D, Poorman GW et al (2018) Predictive model for distal junctional kyphosis after cervical deformity surgery. Spine J 18(12):2187–2194CrossRef

26.

Knafo S, Court C, Parker F (2014) Predicting sagittal deformity after surgery for intramedullary tumors. J Neurosurg Spine 21(3):342–347CrossRef

Title: Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study
Authors: Charles Tatter
Alexander Fletcher-Sandersjöö
Oscar Persson
Gustav Burström
Per Grane
Erik Edström
Adrian Elmi-Terander
Publication date: 01-11-2020
Publisher: Springer Vienna
Keyword: Laminectomy
Published in: Acta Neurochirurgica / Issue 11/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04416-4

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Springer Medicine

Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study

Abstract

Background

Object

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Object

Methods

Results

Conclusions

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