Postoperative kyphosis following resection of pediatric intramedullary spinal tumors: a systematic review and meta-analysis of laminoplasty versus laminectomy.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
OBJECTIVE: Postoperative kyphosis remains a significant complication following intramedullary spinal tumor resection in pediatric patients, occurring in up to 50% of cases. Laminoplasty, rather than laminectomy, theoretically prevents this complication by preserving the integrity of the posterior column. This study aimed to evaluate the incidence of postoperative kyphosis following laminectomy versus laminoplasty in pediatric intramedullary spinal tumor resection. METHODS: A systematic literature search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across the PubMed, Embase, and MEDLINE databases for studies describing pediatric patients (< 18 years) undergoing intramedullary spinal tumor resection. The ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) tool was used to assess risk of bias. A generalized linear mixed model with random intercepts was used to estimate pooled proportions of postoperative kyphosis using a logit transformation. For comparative analyses, studies reporting both laminectomy and laminoplasty arms were pooled using random-effects odds ratios. Heterogeneity was assessed using I2 statistics and Cochran's Q test, and prediction intervals were calculated for pooled estimates. Meta-regression was used to evaluate study-level predictors of postoperative kyphosis. RESULTS: Among 385 records identified, 32 studies met inclusion criteria for systematic review, consisting of 280 pediatric patients undergoing intramedullary spinal tumor resection via laminectomy (n = 175) or laminoplasty (n = 105) with a mean follow-up of 78.4 months. Case reports were included in the qualitative synthesis and descriptive summaries but were excluded from quantitative pooling; 12 studies with extractable postoperative alignment outcomes contributed to meta-analysis (260 patients). In random-effects meta-analysis, the pooled prevalence of postoperative kyphosis was 36% (95% CI 19%-58%; prediction interval 2%-94%). Subgroup analysis showed a prevalence of 46% (95% CI 30%-62%) after laminectomy and 20% (95% CI 2%-73%) after laminoplasty. Comparative meta-analysis of 5 studies showed no significant difference between approaches (OR 1.24, 95% CI 0.32-4.83; I2 = 23.5%; prediction interval 0.25-6.14). In meta-regression, a higher rate of preoperative spinal deformity was linked to postoperative kyphosis (p = 0.0001), while age, sex, and number of levels exposed were not. CONCLUSIONS: Postoperative kyphosis frequently occurs following pediatric intramedullary spinal tumor resection, and no significant difference was found between laminectomy and laminoplasty. Higher study-level rates of preoperative deformity were associated with postoperative kyphosis. Higher-quality comparative studies and standardized postoperative reporting are needed to more confidently assess the relationship between surgical technique and deformity, especially for this vulnerable patient population. Systematic review registration no.: CRD420261286685 (www.crd.york.ac.uk/prospero/).