Review of clinical features of primary spine tumors and tumor-like lesions in children and adolescents

English Keywords:Primary spine tumor  Children  Adolescent  Clinical features

English Abstract:

  【Abstract】 Objectives: To investigate clinical features of spine tumors by analyzing manifestations and treatment outcome of children and adolescents with primary spine tumors and tumor-like lesions. Methods: Medical records and follow-up data of all primary spine tumor and tumor-like lesion cases where patients were under 20 and treated in our center from Februrary 2004 to May 2012 were analyzed retrospectively. Features of interest include symptoms, physical examination, radiological findings and clinical outcome of various treatments in young patients of various ages and types of tumors. Results: The total number of patients was 113, accounting for 25.8% of all patients treated in our center with the same conditions. Among these cases, 104 were diagnosed of benign tumors and tumor-like lesions(51 cases of eosinophilic granuloma, 12 aneurysmal bone cyst, 3 fibrous dysplasia, 3 hemoangioma, 6 Schwannoma, 2 neurofibroma, 7 osteoblastoma, 5 osteochondroma, 7 osteoid osteoma and 8 giant cell tumor); 9 were diagnosed of malignant tumors(4 cases of chordoma, 2 aggressive osteoblastoma, 1 primary neuroectodermal tumor and 2 malignant peripheral nerve sheath tumor). In 82 cases, tumors were in the cervical spine(41 in the upper cervical spine), 10 in the cervico-thoracic spine, 8 in the thoracic spine and 5 in the lumbo-sacral region. Tumors involved in single spinal segment in 88 patients and multiple segments in 25 patients. In 32 cases, tumors were found in the vertebral bodies, 14 in the appendixes, and 26 in both, outside C1-2 region). Focal pain was the chief complain in 98(88.5%) of all 113 cases, and the only complain in 74 cases. Among whom, 71 was found with a tumor in expansive growth, 27 with pathological fractures. In total, 35 patients presented with neurological deficits. Bone destruction was radiologically visible in all patients, whereas only 34/113 cases were found with pathological fractures. There was no significant difference in the occurrence of pathological fracture amongst various tumors. Our cases were treated based on current principle for the treatment of primary spine tumors, including surgery in 62 cases, radiotherapy in 33 cases and simple observation in 18 cases. Follow-up for 8-48 months was obtained in 70 patients. At the last follow-up, 44 patients who underwent surgery had significant pain relief and 22 out of 32 patients who had preoperative neurological symptoms also saw improvement in neurological function. There were 8 cases of tumor reoccurrence(4 cases of malignant and 4 cases of benign tumor), none metastasis. No change was seen in patients who had radiotherapy alone or no treatment at all. Conclusions: Local pain is usually the only symptom in children and adolescents with primary spinal tumors and tumor-like lesions. Radiological features include destruction of bone and sometimes, pathological fractures, yet seldom associated with neurological deficits. Tumors in this age group are much more likely to be benign than malignant; hence a better treatment outcome is to be expected.