Epidural
spinal cord compression by a malignant
tumor is a rare occurrence in children. Both the
tumors involved and the extent of involvement of the vertebral column are different in children and adults. Often, the
epidural tumor in a child is identified before significant spinal canal compromise has occurred, and these children frequently can be managed by
radiation therapy and/or
chemotherapy. There is a group of children, however, who have severe spinal canal encroachment by a
tumor, as evidenced by a near complete or complete block on myelography. In this study, we report a group of patients with severe
spinal cord compression, as documented by imaging studies. We compared the results of a decompressive
laminectomy and subtotal
tumor resection followed by adjuvant
therapy with the results obtained with
radiation therapy and/or
chemotherapy alone. Thirty-three patients met the criteria for inclusion in the study. Twenty-six were treated with a
laminectomy and adjuvant
therapy, and 7 were treated without surgical intervention. With surgical
therapy, 25 of 26 epidurals were either improved or stable, whereas 4 of 7 nonsurgical patients deteriorated. Especially notable was a decrease in
pain in the operative patients immediately after their procedure. There was no surgical mortality or morbidity. The results of this study indicate that children with severe
spinal cord compression as evidenced by a near complete or complete block on myelography or filling of 50% or more of the spinal canal on magnetic resonance imaging are best treated by a combination of
surgical decompression and
tumor removal followed by adjuvant
therapy.