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Preoperative grading scale correlates with progressive spinal deformity in pediatric patients with intramedullary spinal cord tumors, researchers find

Tuesday, October 21 2008 | Comments

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What's This? A preoperative grading scale may predict the progression of spinal deformity following resection of intramedullary spinal cord tumors (IMSCTs) in children, according to the findings of a retrospective, single-center study.

The study was a retrospective record review of 164 consecutive pediatric patients who had undergone surgery to resect IMSCTs at the Johns Hopkins School of Medicine between 1980 and 1994. The mean age of the patients at the time of surgery was 8.6 years, and 61% (n=100) were male. Median follow-up was 9 years.

The scale, with grades ranging from I to V, was developed based on the presence or absence of 4 preoperative variables: scoliosis (a Cobb angle of >10 degrees), surgical decompression involving the thorocolumbar junction, age <13 years at the time of surgery, and the number of previous IMSCT resection surgeries. The score for each patient was cumulative, and the incidence of progressive spinal deformity was evaluated on the basis of the assigned score.

Sixty-three percent of the patients (n=104) had undergone prior IMSCT surgery. Preoperative deformity was present in 32% (n=19) of the 60 patients with no previous surgery. These deformities were all scoliotic. Of the total cohort, 76% of the patients (n=125) underwent radical resection, 20% (n=33) underwent subtotal resection, and 4% (n=6) underwent biopsy.

The preoperative grades were: Grade 1, n=9; Grade II, n=41; Grade III, n=58; Grade IV, n=44; Grade V, n=12. Fusion to treat progressive spinal deformity was subsequently required in 27% of the patients (n=44) after a median of 3.7 years. Analysis revealed that higher grades were increasingly more likely to require additional surgery: Grade V=75%; Grade IV=41%, Grade III=26%, Grade II=5%, and Grade I=0%.

Further analyses showed the same trend in the patients who received either pre- or postoperative radiotherapy, in the patients with a tumor-associated syrinx, and in the patients with a cervical or cervicothoracic tumor who developed progressive spinal deformity postoperatively.

On the basis of these results, the researchers said their grading scale appears to correlate well with the incidence of postoperative progressive deformity of the spine that ultimately requires fusion, and they recommended that Grade IV and V patients be monitored closely for progressive spinal deformity. They cautioned, however, that the scale might not be applicable for patients who present with severe deformation of the spine or evidence of progression of spinal curvature at the time of IMSCT surgery. In addition, they said further studies are required to validate this grading scale. (McGirt MJ, et al. J Neurosurg: Pediatrics 2008;2:277-281.)

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