Management of Musculoskeletal Malformations

Musculoskeletal malformations encountered by pediatric neurosurgeons are frequently manifestations of complex congenital or developmental conditions resulting in neural compression, spinal instability, or spinal deformity. Given the unique anatomy of the pediatric spine and its potential for growth, management decisions are frequently multifaceted and difficult. Management of musculoskeletal malformations in pediatric neurosurgery patients is a broad topic which frequently requires multidisciplinary care. Here, we briefly review the bony and soft tissue development of the spine and outline principles of management of craniovertebral junction abnormalities, Klippel-Feil syndrome, congenital and developmental spinal stenosis, pediatric lumbar disc herniation, and pediatric spondylolisthesis. We also provide a review of genetic conditions and issues which will be encountered by a pediatric neurosurgeon managing these patients. Compared to adult counterparts, pediatric musculoskeletal and spinal malformations requiring surgery are much less frequent. Management involves similar principles to that of adult patients: decompress symptomatic neural elements, stabilize unstable segments, and correct or prevent further deformity. Treatment requires knowledge of the natural history of a patient’s condition and familiarity with a broad range of surgical techniques which must be adapted for the unique anatomy of pediatric patients. With increasing knowledge of conditions leading to these malformations and improved surgical technique, outcomes are continuing to improve for children affected by these disorders.