title: Late surgery for spinal deformities in children previously treated for neural tumors.
abstract: OBJECTIVE
  Surgery for neural tumors occasionally involves opening of the neural canal and/or costovertebral resection that may be followed by radiotherapy. Spinal deformities (SD) may occur in these cases. This study investigated the incidence, surgical indications and results of repair of late SD in a large series of patients with neural tumors.
  
  
  METHODS
  A retrospective review of neural tumors treated between 1991 and 2009 at our institution identified children with SD who subsequently required spinal surgery. SD was meaÂ-sured using Cobb's angle. Instrumentation of the spine was indicated in patients with a Cobb's angle of more than 60° or rapidly progressing SD. The operation was adapted to the location, type and degree of SD. Patients were followed up and the remaining deviations were measured annually.
  
  
  RESULTS
  Out of a series of 188 patients with neural tumors, 5 of 173 patients with neuroblastomas/ganglioneuromas (NB/GN) and 3 of 15 patients with PNET/Askin tumors developed SD over time. NB/GN children had intraspinal tumors requiring laminotomy (n=3) or laminectomy (n=2). PNET/Askin tumor patients had undergone largescale rib and partial vertebral body resection and radiotherapy. Scoliosis or kyphosis were located in the thoracic spine in 4, in the thoracolumbar spine in 3 and in the cervicothoracic spine in 1. The median preoperative Cobb's angle was 65° (50°-90°) prior to spinal surgery performed 2.9 (0.4-11) years after tumor removal. 3 growth bars, 2 vertical expandable prosthetic titanium ribs, 1 pediatric ISOLA device and anterior instrumentation were used. Arthrodesis was necessary in 3 patients. Median post-instrumentation deformity after 3.1 (0.2-12.2) years was 40° (20°-50°), giving an improvement of 38.4%.
  
  
  CONCLUSIONS
  With increasing numbers of children surviving cancer, attention must focus on sequelae. A sizeable number of survivors of NB/GN and PNET/Askin tumors develop serious SD requiring surgical correction. Pediatric surgeons, patients and relatives must be aware of these possible sequelae.
authors.affiliation: Hospital Universitario La Paz, Pediatric Surgery, Madrid, Spain. sbarrena@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Barrena
authors.forename: M
authors.initials: M
authors.lastname: Miguel
authors.forename: C A
authors.initials: CA
authors.lastname: de la Torre
authors.forename: M
authors.initials: M
authors.lastname: Ramírez
authors.forename: M
authors.initials: M
authors.lastname: Díaz
authors.forename: L
authors.initials: L
authors.lastname: Martinez
authors.forename: F S
authors.initials: FS
authors.lastname: Pérez-Grueso
authors.forename: L
authors.initials: L
authors.lastname: Lassaletta
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005729:Ganglioneuroma / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007738:Kyphosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D008297:Male; D009447:Neuroblastoma / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000601:surgery; D013997:Time Factors