目的:超过三分之一接受硬膜内脊柱病变切除的儿科患者出现进行性术后畸形,这些患者中有多达一半需要手术融合。儿童硬膜外脊柱手术同时进行器械融合,然而,很少执行。此外,病人选择的理由,结果,这种儿童单期手术的安全性尚未得到系统研究。在这项研究中,作者回顾了儿科患者同时进行硬膜内脊柱切除和器械融合的实践,并提供了他们机构的两个代表性案例。
方法:作者检索了PubMed和Embase数据库,并按照PRISMA方案进行了系统评价。接受硬膜内脊柱手术的儿科患者(年龄≤18岁)的原始文章,不管病理学,包括伴随的仪器融合和报告的结果。筛选了在3年内年龄≤18岁的患者中进行的所有采用仪器融合的脊柱手术的机构数据库,以识别接受硬膜内脊柱手术并伴随融合的患者。
结果:6项研究中有9例患者(中位年龄12岁)接受了硬膜内病变切除并合并融合治疗,符合纳入标准。在所有11名患者中,伴随融合的主要理由是广泛的骨切除(即,全身切除术或全关节切除术,73%),对多层椎板切除术/椎板成形术的畸形的关注(18%),和严重的基线畸形(9%)。表现最多的病理是神经囊肿(55%),其次是神经鞘瘤(18%)。粘液乳头状室管膜瘤,颗粒细胞瘤,毛细胞星形细胞瘤各1例。7例患者(64%)接受了前路椎体全切术,肿瘤切除,和融合,而其余4例患者(36%)接受了后路手术。所有随访至少1年的患者均实现骨融合。脑脊液漏和新发神经功能缺损各占9%(1/11)。
结论:在迄今为止的研究中,对儿科患者进行单期硬膜内切除和融合术的理由包括存在严重的基线畸形,大量的骨切除,和跨颈胸或胸腰椎交界处的多层椎板切除术/椎板成形术。由于目前涉及这一群体的文献有限,需要更多的数据来确定硬膜内切除合并融合何时适合儿科患者,以及其常规实施是否安全或有益.
OBJECTIVE: More than one-third of pediatric patients who undergo resection of
intradural spine lesions develop progressive postoperative deformity, with as many as half of these patients subsequently requiring surgical fusion.
Intradural spinal procedures with simultaneous instrumented fusion in children, however, are infrequently performed. Moreover, the rationale for patient selection, outcomes, and safety of this single-stage surgery in children has not been systematically investigated. In this study, the authors review the practice of simultaneous
intradural spinal resection and instrumented fusion in pediatric patients and provide two representative case examples from their institution.
METHODS: The authors searched the PubMed and Embase databases and performed a systematic review following the PRISMA protocol. Original articles of pediatric patients (age ≤ 18 years) who underwent intradural spine surgery, regardless of pathology, with concomitant instrumented fusion and reported outcomes were included. An institutional database of all spinal operations with instrumented fusion performed in patients aged ≤ 18 years over a 3-year period was screened to identify those who underwent intradural spine surgery with concomitant fusion.
RESULTS: Nine patients (median age 12 years) from 6 studies who underwent
intradural lesion resection and concomitant fusion met inclusion criteria. Among all 11 patients included, primary rationales for concomitant fusion were extensive bone removal (i.e., corpectomy or total facetectomy, 73%), concerns for deformity in the setting of multilevel laminectomy/laminoplasty (18%), and severe baseline deformity (9%). The most represented pathology was neurenteric cyst (55%) followed by schwannoma (18%). Myxopapillary ependymoma, granular cell tumor, and pilocytic astrocytoma each were seen in 1 case. Seven patients (64%) underwent an anterior-approach corpectomy, tumor resection, and fusion, while the remaining 4 patients (36%) underwent a posterior approach. All patients with at least 1 year of follow-up cases achieved bony fusion. CSF leak and new-onset neurological deficit each occurred in 9% (1/11).
CONCLUSIONS: The rationales for performing single-stage
intradural resection and fusion in pediatric patients in studies to date include the presence of severe baseline deformity, large extent of bone resection, and multilevel laminectomy/laminoplasty across cervicothoracic or thoracolumbar junctions. As current literature involving this cohort is limited, more data are needed to determine when concomitant fusion in intradural resections is appropriate in pediatric patients and whether its routine implementation is safe or beneficial.