Correction of postlaminectomy cervical kyphosis in an operated case of cervical spine primitive neuroectodermal tumor

A 14-year-old boy presented with gradually worsening spastic quadriparesis and cervical kyphotic deformity as a consequence of laminectomy for tumor debulking and chemoradiotherapy done 2 years prior for cervical primitive neuroectodermal tumor. Problems to be addressed particularly to the case were a rigid kyphosis of 102.7°, poor soft-tissue coverage, internal gibbus compressing cord, perched facets, and superficial location of cord. The surgery was staged, in that the first anterior release was done with gradually increasing traction to correct the kyphosis progressively. Posterior instrumentation was done in the second stage. Finally, anterior reconstruction with tricortical iliac bone grafting was done. The patient regained full power with complete union at the end of 18 months. Irradiation of tumor along with laminectomy results in loss of posterior tension band which results in progressive kyphotic deformity in children. A staged plan of surgical interventions can help in postoperative correction of deformity with circumferential union and prevention of recurrence. This article describes successful treatment of a patient with postlaminectomy cervical kyphosis with 77° of correction achieved postoperatively and also highlights the importance of anterior and posterior reconstructions to achieve a stable vertebral column.

Key-words:

Cervical kyphosis - pediatric population - postlaminectomy

Financial support and sponsorship

Nil.

Publication History

Article published online:
09 September 2022

• References

• 1 Breig A, el-Nadi AF. Biomechanics of the cervical spinal cord. Relief of contact pressure on and overstretching of the spinal cord. Acta Radiol Diagn (Stockh) 1966;4:602-24.
• 2 Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000;93:199-204.
• 3 Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine (Phila Pa 1976) 1988;13:447-9.
• 4 Cattell HS, Clark GL Jr. Cervical kyphosis and instability following multiple laminectomies in children. J Bone Joint Surg Am 1967;49:713-20.
• 5 Mayfield JK, Riseborough EJ, Jaffe N, Nehme ME. Spinal deformity in children treated for neuroblastoma. J Bone Joint Surg Am 1981;63:183-93.
• 6 Lutz FS, Munhoz da Rocha LE. Post-laminectomy deformities. Coluna Columna 2014;13:279-81.
• 7 Robert H, Bortolussi C.In vitro evolution of the pressure and the geometry of the lumbar disc as a function of the stability of the spine. J Biophys Med Nucl 1984;8:243-9.
• 8 Tanaka M, Sugimoto Y, Misawa H, Takigawa T, Kunisada T, Ozaki T, et al. Segmental pedicle screw fixation for a scoliosis patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis of spinal astrocytoma. Acta Med Okayama 2012;66:363-8.
• 9 Otsuka NY, Hey L, Hall JE. Postlaminectomy and postirradiation kyphosis in children and adolescents. Clinical Orthopaedics and Related Research 1998;354:189-94.
• 10 Yasuoka S, Peterson HA, MacCarty CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg 1982;57:441-5.
• 11 Kelley BJ, Johnson MH, Vortmeyer AO, Smith BG, Abbed KM. Two-level thoracic pedicle subtraction osteotomy for progressive post-laminectomy kyphotic deformity following resection of an unusual thoracolumbar intradural extramedullary tumor. J Neurosurg Pediatr 2012;10:334-9.