Recovery From Treatment for Intramedullary Spinal Cord Tumors in Children

Postoperative Orders

• Frequency of vital signs: The frequency for monitoring vitial signs is a function of the level of surgery. Upper cervical tumors raise concern about respiratory collapse and aspiration. Patients should be in a monitored environment where rapid intervention can occur if respiratory distress arises. It may be appropriate to keep the patient on a ventilator the first night after surgery.
• HOB: The HOB setting is a function of the level of operation. Patients with cervical and upper thoracic tumors can have their HOB raised as tolerated. Patients with lower thoracic tumors should be flat in bed for several days until drain outputs slow to near zero.
• Activity: Activity is advanced as tolerated once the patient’s sitting in bed does not raise concern over CSF leakage from the wound.
• Diet: Diet may be advanced as tolerated.
• Steroids: Steroids are tapered over 5–7 days. If there is concern about chemical meningitis, steroid taper may be delayed for several days.
• Antibiotics: Antibiotics are not required.
• Narcotics: Narcotics are used the first night and then may be replaced by ketorolac.
• Oncology consultation: Consultation by an oncologist is requested to assist in establishing a long-term management plan.
• Rehabilitation medicine consultation: Consultation by rehabilitation medicine is requested to arrange for physical therapy support when needed and to prepare for an anticipated inpatient rehabilitation requirement.
• Immediate MRI: Usually a scan is obtained within several days of surgery to confirm the surgeon’s impression of the degree of resection.  This allows for the appreciation of an inadequate resection and consideration of a reoperation for further resection before healing and scarring set in.

Postoperative Morbidity

The immediate postoperative period will be dominated by altered sensation with associated dysesthesia.  This occurrence, coupled with enforced bed rest, can cause distress in patients, especially when they have not been warned that it will occur.  Time should be spent before surgery counseling patients about what to expect.

• Bed rest: Bed rest will be required for several days for most patients prior to advancing their activities, particularly when there is a concern over risk for CSF leakage.
• Sensory disabilities: Sensory disabilities are the major disability once the level of activity is advanced. Dysesthesias are not uncommon. Proprioception difficulties increase with age, becoming common in mid-childhood. This level of sensory disability typically requires inpatient rehabilitation for optimal outcome, either during the acute hospitalization or at a rehabilitation facility. Rehabilitation can require several weeks to several months.