Orthopaedic Aspects of Intraspinal Tumors in Infants and Children

Abstract

1. A consecutive series of 115 intraspinal tumors in infants and children, treated between 1933 and 1963 at the Children's Hospital Medical Center, Boston, is presented. About one-half of the tumors were treated during the first four years of life; these included congenital cysts, dermoid and teratoid tumors, and many neuroblastomata. Intramedullary gliomata were encountered in children of all ages. Neurofibromata and meningiomata, which are so common in adults, were rarely seen in these children. 2. The clinical picture, laboratory findings, and differential diagnosis are discussed. The importance of early diagnosis and treatment before the development of extensive neuromuscular damage is stressed. This is most important, because many of these lesions are benign and grow very slowly. 3. Whenever an intraspinal tumor in a child is suspected, adequate investigation is imperative including (a) repeated careful motor, reflex, and sensory examination and evaluation of sphincter function; (b) examination of cerebrospinal-fluid dynamics and protein content by lumbar puncture; (c) careful examination of roentgenograms of the entire spine; and (d) myelography whenever any abnormality in the foregoing studies is detected. 4. Treatment and results are presented. Forty-seven of the 115 patients died less than eight years after operation. One patient died fifteen years and another twenty-four years following surgery. Of the sixty-six patients still alive, fifty-eight were recently examined by the authors. The length of follow-up ranged from one to thirty years, with an average of twelve years. 5. Postoperatively, 83 per cent of all patients required orthopaedic care because of musculoskeletal abnormality. Experiences with orthopaedic management of paralytic deformities of the extremities and spine are presented. Scoliosis occurred in thirty-six patients and kyphosis in thirty patients. The importance of postoperative support to the spine in growing children with intraspinal tumors is emphasized. This is especially true when laminectomy is extensive, when there is associated muscle weakness, and after irradiation of the spine. Orthopaedic surgical treatment is indicated only when one is sure that the disease process is not progressive and that the pattern of paralysis is not changing. 6. It is hoped that this presentation will alert all physicians to the possibility of spinal-cord tumor whenever a child is found to have torticollis, scoliosis, unexplained limp, weakness of an extremity, sphincter disturbance, or an obscure pain in the trunk or art extremity. It is further hoped that with earlier diagnosis of the frequently benign slowly growing intraspinal tumors of childhood, much irreversible damage to the spinal cord can be prevented. Expert neurosurgical treatment of these tumors must be supplemented by immediate and continued orthopaedic management to minimize the occurrence and severity of fixed deformities of the spine and extremities.