Abstract: It is known that the treatment of intra or extraspinal paediatric tumours with surgery and radiotherapy or radiotherapy alone can lead to the onset of progressive spinal deformity the management of which can be extremely challenging. We review our series of patients who have developed a spinal deformity in these circumstances.

Methods: A review of all patients seen between 1996 and 2007 in the spinal department who have developed a significant spinal deformity following treatment for an intra or extra spinal tumour.

Results: 14 patients were identified. The age of presentation to the spinal service was between 2 years 6 months and 15 years 3 months. The underlying diagnoses were Wilms Tumour treated with surgery and radiotherapy in 3, 1 extraspinal sarcoma treated with surgical resection, radiotherapy and chemotherapy, 1 extraspinal neuro-blastoma treated with surgery, radiotherapy, chemotherapy and stem cell rescue and 9 intra spinal tumours (PNET, astrocytoma, ganglioneuroblastoma and der-moid) all managed with resection with or without radiotherapy. The spinal deformities that have developed were thoracic kyphoscoliosis, thoracolumbar kyphosis and lumber hyperlordosis. The spinal management of these deformities has been conservative in 12 with regular assessment to allow intervention if indicated. 2 patients have undergone surgery, a vascularised fibular strut graft and anterior instrumentation in 1 and a non vascularised rib graft in 1 for progressive deformity felt to lead to neurological dysfunction or lung hypoplasia. The cases managed operatively were complicated by poor posterior soft tissues following previous surgery and radiotherapy requiring an anterior approach. In all patients who were treated with radiotherapy platyspondyly was always seen in the vertebral bodies anteriorly and this corresponded to the apex of the deformity.

Conclusion: In all children who undergo spinal surgery and or radiotherapy for paediatric tumours there must be ongoing surveillance for the development of a spinal deformity. We feel that this is as much a result of anterior growth arrest secondary to radiotherapy as to posterior laminectomy for intra canal tumour excision. The surgical management of this problem is complex and may require innovative solutions.

Objective: To extend the follow up period of previous studies undertaken by the senior author, looking at the clinical outcome and radiological changes observed in patients with either myelopathy or radiculopathy, following anterior cervical discectomy without fusion.

Design: Prospective, observational cohort study of patients undergoing anterior cervical discectomy without fusion and followed up for five years, radiologically, with serial plain radiographs, and clinically, using validated outcome measures including SF36, neck disability index and analogue visual pain scores.

Subjects: 109 Patients undergoing anterior cervical dis-cectomy without fusion under the senior author’s care.

Outcome measures:

Radiological

Occurrence of segmental cervical kyphosis

Results: A total cohort of 109 patients, of mean age 56 years, were followed up after anterior cervical discectomy without fusion, for up to 5 years. Segmental kyphosis was demonstrated on 44%, and loss of overall cervical alignment on 60% of follow up plain radiographs during the third postoperative year. In the cohorts of patients with either loss of cervical alignment or segmental kyphosis at one year the mean clinical outcome scores (Wilcoxon’s matched pairs signed ranks test) continued to improve at the 5 year follow up. The annual rate of loss of cervical alignment in patients unaffected at the first post operative year was around 10% but there was no significant rate of progression of segmental kyphosis. Comparison of the relationship between these radiological changes and clinical outcome (Mann-Whitney U test) did not show any significant correlation.

Conclusions: This study assesses patients over the period during which the anticipated alignment changes associated with undertaking simple anterior cervical discectomy could be having progressive detrimental clinical effects. Where such radiological changes occur they most commonly occur during the first post operative year. However, clinical outcome measures in these patients all improve at one year follow up, and still continue to improve or plateau up to five years post operatively. As anticipated, the most significant clinical improvement, occurs during the first post operative year. During the longer follow up period there is no significant detrimental effect of the radiological changes discussed on clinical outcome.

Introduction: The natural history of scoliosis in the presence of a cord syrinx, either treated conservatively, or post surgically, is disputed. It is generally believed to be associated with a greater likelihood of rapid deformity progression pre-operatively and a much greater likelihood of intraoperative neural injury.

In this study we aimed to retrospectively assess the local experience by reviewing patients, treated over the last 10 years, in whom scoliosis has been established, by means of MR imaging, to be associated with a cord syrinx.

Methods: A retrospective cohort study was undertaken of paediatric patients attending the Leeds Spinal Unit between the years of 1997 and 2007. The entry criteria for this study were spinal deformity with MRI proven cord syrinx, in a patient without underlying tumour or other cord anomaly. Given the association with Chiari malformation this was a measured parameter rather than exclusion criteria. Other parameters assessed were mode of presentation, progression of scoliosis, details of the identified syrinx, chosen mode of treatment for the syrinx and the scoliosis (including conservative) and outcome measures (neurological function and sequelae, change in Cobb angle/deformity correction).

Results: A total of 46 patients were identified with scoliosis and an associated syrinx. The age range was from 3 to 18 years. Only 12 were male. The syrinx was associated with an Arnold Chiari malformation in 24% of patients, and located at the apex of, or local to, the maximum deformity in 73%.

The syrinx was treated surgically in 10 patients, with 80% of these achieving either deformity arrest, or no longer requiring surgical deformity correction. In the 2 patients from the same subset who did undergo deformity correction there was no neurological sequelae. Of the conservatively managed syrinxes, deformity correction with intraoperative cord monitoring was nevertheless undertaken in 31%, all without neurological sequelae. In just 4 patients (of 69%) who did not proceed to deformity correction, surgery was precluded by the inherent risks in the presence of an untreated syrinx.

Conclusion: This small series does not lend support to the literature and anecdotal evidence for significantly increased surgical risk in deformity correction without treatment for syrinx first. However, this may reflect the fact that all syrinxes likely to compromise the surgical procedure were assessed as such and treated first. In the cohort of patients whose syrinxes were treated conservatively, a significant proportion did not require subsequent deformity surgery. Identifying a syrinx by, the mandatory, MR imaging of a patient with a deformity before considering surgical correction, appears to identify a significant proportion of syrinxes which neither significantly accelerate the progression deformity, or which do not lead to poor outcome after deformity surgery.

Objective: Anterior cervical discectomy (ACD) has been established for 40 years. Most surgeons introduce an interbody spacer despite randomised evidence, which suggests this is unnecessary. Surgeons are concerned about the effects of discectomy on cervical spine alignment causing neck pain and accelerated degenerative changes at adjacent levels. In this study we have investigated the relationships between pre-operative disc height, post-operative radiological changes and clinical outcome following ACD.

Design: Prospective cohort study of patients undergoing ACD

Subjects: Seventy-three patients undergoing ACD for the treatment of cervical myelopathy or radiculopathy. Minimum follow up one year.

Outcome measures: SF 36, Neck Disability Index, visual analogue scores for neck and arm pain, cervical spine alignment, segmental kyphosis, and disc height.

Results: Greater pre-op disc height predicts greater post op percentage loss of disc height but does not correlate with poor outcome (p> 0.05 all measures). Post- op X-rays revealed disturbed alignment in 54% of patients. Analysis of clinical outcome showed no statistical differences in any of the clinical outcome measures between patients with and without radiological abnormalities (p> 0.05) SF 36 scores were significantly worse than population controls in patients with and without radiological abnormalities.

Conclusions: Large discs collapse more than small discs but this does not compromise outcome. Radiological changes occurred in a significant number of patients in this cohort. These abnormalities do not appear to influence clinical outcome at 12–24 months. The study continues and will report outcomes at five years.