gms | German Medical Science

Objective: Pediatric spine tumors are usually primary spine tumors and extremly rare. Thus, there is little knowledge and experience about incidence and type and especially management of complications. Here, we report on our 10 years-experience concerning complications and management of complications within in a pediatric spine population.

Method: Retrospective study. 29 patients, treated between January 2002 and december 2012, extracted from our databank, driven for more than 20 years by one coauthor.

Results: 16 girls, 13 boys, mean age 13 years, harbouring 22 benign (including 10 aneurysmatic bone cysts, 6 osteoblastoms), 7 malign lesions (chondro-, Ewing's-, osteosarkoma). Single location within the spine in 17 (58%), several locations all over the spine in 12 patients (42%). Predominantely, the cervical spine was involved in 14 out of 29 (48%). 24 out of 29 (83%) kids did not have any neurological symptoms. Recurrence was seen in 5 cases (17%).

Complications were seen in 14 out of 29 patients (48%): Among these, Horner's syndrom (1) and cerebral confusion (1) have been treated conservatively. Local scin necrosis/ infection (2), perforation at the posterior pharyngeal wall following transoral approach (1) requiring local revison together with ENT-surgeons, pleural effusions, requiring temporary drainage and pleurodesis (1) are easy to treat. However, massive blood loss during surgery – requiring massive transfusion of 20 liters is difficult to handle, even after successful surgical intervention. Segmental kyphotic angulation (2) and implant failure (1), or local recurrence of the tumor in 5 cases were very difficult to handle mandating different operative approaches, long distance stabilization, bone grafting, and transplantation. Moreover, postop intensive care unit staff must be prepared to deal with these problems. 2 kids died, 3 are lost for follow-up in eastern european countries or arabia.

Conclusions: Complications occur in almost 50% of kids harboring primary spine tumors. The range of complications is extremely widespread. Major complications require long term experience, routine, complex approaches. Thus, these kids should be treated in specialized spine centers exclusively.