Primary Malignant Spinal Tumors in Children: 21-years Retrospective Single Surgical Clinic Study

Abstract

IntroductionPrimary malignant spinal tumors in children are difficult due to the rarity, the lack of specificity of signs and controversial treatment strategy [Belogurova M.B. 2002]. Pain prevails in children (more than 80%); spinal deformity, neurological deficits, bladder and bowel dysfunction occurred more than 50% of cases [Walker D.A., et al., 2004; Huisman TA., 2009]. The radical surgery has a prevalence for a long-time surveillance, but the results of the treatment not frequently discuss.Material and Method: The retrospective study includes 28 patients aged from 1 year 6 months till 17 years who were consequently admitted from 1993 till 2014 into single clinic which specialized on the surgical treatment of skeleton destruction in children. The radiation study included X-ray, CT and MRI for indication of tumors borders, degree of vascular support, the presence of necrotic focuses and oncology staging according to Enneking. The radiation scanning with Тс99 was done for patients above 4 years old. Neurological status was estimated by ASIA and Frankel scale. The results of the complex (ChT + Surgery) treatment were studied with FU no less than 1year. ResultsThe malignant Hodgkin's and non-Hodgkin's lymphomas were the most frequent in children (15 cases, incl. 10 boys and 5 girls). The cervical, thoracic, lumbar and sacral spine were affected in 1, 9, 12 and 2 cases respectevely. 9 patients (60%) had multi-level lesions. SaEwing/PNET was verified in 8 (3 boys and 5 girls). The cervical, thoracic, lumbar and sacral vertebrae were affected in 3, 1, 5 and 2 patients respectively. The multi-level lesion was in 3 cases (37%). The other sarcomas (polymorphous, epithelioid, histiocytic and angiosarcoma) were in 4 patients, incl. 2 cases of cervical lesion and one with thoracic and lumbar spine. The thoracic spine malignant histiocytosis was in one case. The pain, spinal deformity and neurological symptoms were dominant in 25 (89%) cases; the high temperature and weakness - in 3 (11%). The diagnosis was confirmed by trans-cutaneous fluoroscopic(C-arm)-navigated biopsy followed by cytology and morphology; the open biopsy used only in 3. The decision for spine reconstruction was accepted together with oncologists after chemotherapy in 18 children (64.2%) (8 - lymphomas, 6 - SaEwing/PNET, 4 - other Sa). According to the retrospective study all operated patients were estimated as 7 and more degrees according to SINS. En block resection was done in 5. The 5-year survival rate after spinal reconstruction was 66,6% (12 from 18). Among the dead 2/6 had lymphomas, 3/6 - SaEwing/PNET and one – polymorphous cells Sa. Parents regrets complex chemotherapy in 2/6. ConclusionsSurgical treatment for malignant spinal tumors in children has to be included into complex therapy with chemotherapy and, perhaps, radiation therapy, but the data of RT’ in children still controversies. The time and volume of surgery have to be adopt together with pediatric oncologist and spinal surgeon. Radical surgery with restoration of spinal stability significantly improves the long-time survival rate as a functional and motion activity in pediatric patients even with a high malignant spinal tumors.