Primary tumors of the spine in children - Natural history, management, and long-term follow-up

Study Design. Patients 16 years of age and younger with primary vertebral neoplasms diagnosed between 1951 and 1996 at The University of Iowa were reviewed retrospectively with specific consideration given to follow-up. Objective. Follow-up extending beyond the growth of the axial skeleton was used to establish the natural history, management, outcome, and current approach to treatment. Summary of Background Data. Primary tumors of the spine are uncommon. The treatment of such lesions generally has been based on small series of tumors, or extrapolated from the treatment of tumors in other regions and tumors in adults. Given the unique developing anatomy and dynamic nature of the growing spine in children, delineating appropriate modalities or treatment for these tumors beyond the growth of the axial skeleton is essential. Methods. Clinical history, radiographs, radiographic reports, and interviews were used to establish this database. Outcome with respect to the various approaches to treatment was then compared in detail. Results. Forty-five patients were identified in which follow-up greater than 10 years was available for 58% of patients. There were 29 histologically benign and 16 malignant tumors. Patients presented most frequently with pain (79%) and neurologic deficits (74%). The duration of symptoms was significantly shorter with malignant tumors (11 weeks) compared with benign tumors (26 weeks). Radiographic abnormalities were demonstrated on plain radiographs in 98% of cases. Tumor excision was achieved in 80%. Follow-up studies were available beyond the growth of the axial skeleton in these patients, with an average follow-up of 14 years. Recurrence was seen in 6 of 45 children, and the overall mortality rate was 6.7%, occurring only with malignant tumors. Conclusion. Our current approach to treatment of spinal neoplasms varies from that used in the earlier part of the series and reflects the need for single stage complete resection and stabilization.