Abstract
Multilevel laminectomy in children has a significant rate of postoperative spinal deformity. To decrease the incidence of this complication, the use of osteoplastic laminotomy is advocated to minimise the risk of spinal deformity by preserving the normal architecture of the spine. In this retrospective study, a 10-year series of a paediatric population undergoing multilevel osteoplastic laminotomy is reviewed to determine the incidence, especially in contrast to laminectomies, and to identify factors that affect the occurrence of spinal column deformity. Seventy patients (mean age 4.2 years) underwent multilevel osteoplastic laminotomy for congenital anomalies or removal of spinal tumours. All patients had a clinical and radiographic examination preoperatively, 12 months postoperatively and at follow-up. Mean follow-up was 5.3 years (range 3–12.6 years). Nineteen patients (27%) had a new or progressive spinal deformity. There was an increased incidence in patients who had surgery for spinal tumours (P < 0.05), surgery of the cervical spine (P < 0.01), and who had more than five levels of the spine included (P < 0.05). A review of the literature on children with multilevel laminectomy (n = 330), the incidence of spinal deformity found a significantly higher (46%) compared to our study group. This study demonstrates that osteoplastic laminotomy was found to be very effective in decreasing the incidence of spinal deformities after spinal-canal surgery for spinal-cord tumours or congenital anomalies in children and adolescents. The choice of an anatomical reconstructive surgical technique such as osteoplastic laminotomy seems to be essential to minimise secondary problems due to the surgical technique itself. Nevertheless, growing patients should be followed up for several years after the initial operation for early detection and consequent management of any possible deformity of the spinal column.
Résumé
La laminectomie étagée chez l’enfant entraîne un taux important de déformations rachidiennes post-opératoires. Pour diminuer l’incidence de cette complication nous utilisons la laminotomie ostéoplastique qui sert à préserver une architecture normale du rachis. Dans cette étude rétrospective, une série d’enfants a été revue sur 10 ans de façon à déterminer l’incidence de ces déformations en comparaison avec la laminectomie. 70 patients (âge moyen 4,2 ans) ont bénéficié d’une laminotomie ostéoplastique pour anomalie congénitale ou pour résection tumorale. Les patients ont bénéficié d’un suivi clinique et radiographique, le suivi moyen a été de 5,3 ans (de 3 à 12,6 ans). 19 patients (27%) ont présenté une déformation progressive du rachis. Celle-ci est plus importante dans les résections pour tumeurs (P < 0.05) et au niveau de la colonne cervicale (P < 0.01) et lorsque 5 niveaux ont été inclus sur le plan chirurgical (P < 0.05). La revue de la littérature à propos de 330 laminectomies a montré une incidence des déformations rachidiennes de 46% comparé au 27% de notre série. Cette étude démontre que la laminotomie ostoplastique est une chirurgie qui diminue l’incidence des déformations rachidiennes après chirurgie pour malformation ou tumeur. Néanmoins, ces patients devront être surveillés pendant toute la période de croissance de façon à détecter une déformation éventuelle.
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Raab, P., Juergen, K., Gloger, H. et al. Spinal deformity after multilevel osteoplastic laminotomy. International Orthopaedics (SICO 32, 355–359 (2008). https://doi.org/10.1007/s00264-007-0325-x
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DOI: https://doi.org/10.1007/s00264-007-0325-x