Spinal Tumor Surgery in Children: Risks and Post-Operative Considerations

Spinal tumor surgery and subsequent issues with hardware (screws)?

Hello Doctor, my child is currently 5 years and 7 months old.
A spinal tumor was detected at birth, and initially, we were just monitoring it regularly.
During this time, we learned that the tumor had grown into the spinal canal, specifically located at thoracic vertebrae 9-12 and lumbar vertebrae 1-3, and it surrounds the spine! When my child was 3 and a half years old, he suddenly experienced weakness in both legs, which led to surgery to remove part of the tumor at thoracic vertebrae 9-12 to relieve pressure on the nerves.
Two years have passed, and recently the tumor has grown again, returning to the 9-12 vertebrae area! We are currently considering another surgery, where the doctor plans to remove most of the tumor and insert screws to stabilize the spine.

I have a few questions:
1.
After the tumor is removed, will the sudden loss of support from the tumor cause the spine to collapse due to inability to bear weight?
2.
If screws are placed where the tumor was removed, will this affect my child's growth? Will the screws need to be replaced later, or can they provide support for a period of time and then be removed without needing further support?
3.
There are inherent risks associated with spinal tumor surgery.
Given that my child is still young, is it advisable to proceed with surgery immediately, or should we continue to monitor since he currently shows no signs of weakness or pain, and only consider surgery if symptoms arise later?
I would appreciate your advice on these matters.
Thank you! 🙏

Steven, 30~39 year old female. Ask Date: 2020/05/22

Dr. Zhang Junwei reply Neurosurgery

Since the child is only 5 years old and there is no detailed medical history, this issue is too specialized and complex, falling under the scope of pediatric neurosurgery.
It is recommended to consult a physician in an outpatient setting.

Reply Date: 2020/05/22

More Info

When considering spinal tumor surgery in children, particularly in a case like your child's, there are several important factors to take into account. Given the complexity of spinal tumors and the potential implications for a growing child, it is crucial to weigh the risks and benefits of surgical intervention carefully.

1. Risk of Spinal Collapse Post-Surgery: When a tumor is removed, especially one that has been providing structural support to the spine, there is a concern about the stability of the vertebrae. In your child's case, the tumor has been surrounding the spine, and its removal could potentially lead to instability. However, surgeons typically assess the structural integrity of the spine before surgery. If there is a significant risk of collapse, the surgeon may recommend spinal instrumentation, such as rods and screws (often referred to as "hardware"), to stabilize the spine after tumor removal. This stabilization helps prevent vertebral collapse and supports the spine during the healing process.

2. Impact on Growth and Future Surgeries: The placement of rods and screws in a child's spine can have implications for growth. Pediatric surgeons are trained to consider the growth potential of the child when planning surgery. In many cases, the hardware can remain in place for several years, and it may not need to be replaced unless there are complications, such as infection or hardware failure. In some instances, surgeons may opt for removable hardware, allowing for future adjustments as the child grows. The decision to remove or replace hardware will depend on the child's growth, the stability of the spine, and the presence of any symptoms.

3. Timing of Surgery: The decision to proceed with surgery should be based on a comprehensive evaluation of the child's condition. If the tumor is growing and causing symptoms, such as weakness or pain, surgical intervention may be warranted even if the child currently appears stable. However, if the tumor is not causing any immediate issues, a conservative approach with regular monitoring may be appropriate. It is essential to have a detailed discussion with the surgical team about the risks involved, the expected outcomes, and the potential for future complications.
In summary, while surgery for spinal tumors in children carries inherent risks, it can also provide significant benefits, particularly in preventing neurological deficits and improving quality of life. It is crucial to have a thorough discussion with a pediatric neurosurgeon or orthopedic surgeon who specializes in spinal conditions to understand the best course of action for your child. They can provide insights based on the specific characteristics of the tumor, the child's overall health, and the potential impact on growth and development. Regular follow-ups and imaging studies will also be necessary to monitor the child's condition post-surgery.

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