Our Summary

This research paper looks into a method to treat children who have developed a spinal condition called kyphosis, which is a forward rounding of the back, after having undergone radiation therapy and a type of spinal surgery called a laminectomy. The researchers studied the use of a vascularized rib graft (VRG), which is a piece of rib with its blood supply, to help strengthen the spine during spinal fusion surgery. Spinal fusion surgery is often unsuccessful in patients who have had radiation therapy due to the poor quality of the bone.

The researchers collected information from the medical records of children who had been treated at a single hospital and who had had this type of surgery between December 2003 and August 2015. The records of five patients were included in the analysis and the results of their imaging studies were examined by three experienced pediatric orthopedic surgeons.

The researchers found that the use of a VRG was successful in all five patients, as defined by a successful spinal fusion evident on a CT scan, no failure of the implanted material, and no progression of the kyphosis. The follow-up period ranged from 21 to 63 months. One patient experienced complications - a tear in the esophagus and a deep infection.

Overall, the study concluded that the use of a VRG during spinal fusion surgery is a promising treatment option for children who have developed kyphosis after radiation therapy and laminectomy. The VRG provides a non-irradiated piece of bone with its own blood supply to help support the spine.

FAQs

  1. What is the aim of the study on post-laminectomy and post-irradiation kyphosis in children?
  2. What is a vascularized rib graft (VRG) and how is it used in the treatment of kyphosis in children?
  3. What were the results and outcomes of the study on the use of VRG in the treatment of kyphosis following laminectomy and irradiation?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal laminectomy is to follow post-operative care instructions carefully, including proper wound care, physical therapy exercises, and avoiding activities that could strain the spine. It is also important to attend follow-up appointments to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended spinal laminectomy include those with:

  1. Spinal stenosis: Narrowing of the spinal canal causing compression of the spinal cord and nerves.
  2. Herniated disc: When the gel-like center of a spinal disc pushes through a tear in the outer layer, causing pain and discomfort.
  3. Spinal tumors: Abnormal growths in or near the spinal cord that may require surgical removal.
  4. Degenerative disc disease: Wear and tear on the spinal discs over time, leading to pain and decreased mobility.
  5. Spondylolisthesis: When a vertebra slips out of place and onto the vertebra below it.
  6. Spinal injuries: Traumatic injuries to the spine that may require surgical intervention for stabilization and repair.

Timeline

  • Before spinal laminectomy:
  1. Patient experiences symptoms of spinal stenosis or a herniated disc, such as back pain, leg pain, or weakness.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to confirm the diagnosis.
  3. Patient may try conservative treatments such as physical therapy or medication before opting for surgery.
  4. Patient and surgeon discuss the risks and benefits of spinal laminectomy and decide on the best course of treatment.
  • After spinal laminectomy:
  1. Patient undergoes the surgical procedure, during which the lamina (back part of the vertebra) is removed to relieve pressure on the spinal cord or nerves.
  2. Patient may experience some pain and discomfort after surgery, which is managed with pain medication.
  3. Patient undergoes physical therapy to strengthen the muscles supporting the spine and improve mobility.
  4. Patient gradually resumes normal activities and may experience improvement in symptoms such as pain and weakness.
  5. Patient continues to follow up with their surgeon for monitoring and potential further treatment if needed.

Overall, the goal of spinal laminectomy is to relieve pressure on the spinal cord or nerves, improve symptoms, and restore function and mobility to the patient.

What to Ask Your Doctor

  1. What is a spinal laminectomy and why is it needed?
  2. What are the potential risks and complications of a spinal laminectomy?
  3. How will a spinal laminectomy affect my spinal stability and function?
  4. What is post-laminectomy kyphosis and how is it treated?
  5. What are the potential risks and benefits of using a vascularized rib graft (VRG) for spinal fusion?
  6. How successful is VRG in treating post-laminectomy and post-irradiation kyphosis in children?
  7. What is the expected recovery time and outcome after undergoing a VRG procedure?
  8. What are the potential long-term effects of using a VRG for spinal fusion?
  9. Are there any alternative treatments or procedures for post-laminectomy and post-irradiation kyphosis?
  10. What follow-up care and monitoring will be needed after undergoing a VRG procedure?

Reference

Authors: Rogers N, Selberg C, LaMotta C, Beebe C, Bloch N, Erickson M, Donaldson NJ. Journal: Orthopedics. 2021 Jul-Aug;44(4):e563-e569. doi: 10.3928/01477447-20210618-18. Epub 2021 Jul 1. PMID: 34292816