Oh, what a surprise! It turns out that slicing and dicing the spines of kids might just lead to a bit of a wonky back. Who would’ve thought, right? In a groundbreaking revelation, more than a third of kids who had their intradural spine lesions removed ended up with progressive postoperative deformity. And, hold your breath, half of these little contortionists might need to go under the knife again for surgical fusion. But wait, there’s more! Despite this fun fact, doctors rarely decide to throw in a simultaneous instrumented fusion during the first go-around. Why, you ask? Well, it seems the medical world is a bit shy about systematically investigating the why, the outcomes, and the safety of this all-in-one special for kids.

In a daring move, some researchers decided to dive into the world of simultaneous intradural spinal resection and instrumented fusion in pediatric patients, showcasing two whole case examples from their very own collection. They scoured the vast expanses of PubMed and Embase, following the breadcrumbs left by the PRISMA protocol. Their quest? To find those brave souls (aged ≤ 18 years, because let’s face it, adults are a whole different ball game) who underwent this mystical surgery combo and lived to tell the tale.

After what I can only imagine was an exhaustive search, they found nine patients (median age: 12 years, because apparently, that’s when you’re ripe for spine tinkering) from six whole studies. The reasons for this surgical extravaganza included extensive bone removal (because who needs bones anyway?), fear of turning into Quasimodo after a multilevel laminectomy/laminoplasty, and severe baseline deformity (because starting off wonky only means you can get wonkier).

The most popular guest at this spine party was the neurenteric cyst, followed by the ever-so-charming schwannoma. And let’s not forget the one-hit wonders: myxopapillary ependymoma, granular cell tumor, and pilocytic astrocytoma. Most kids got the front-door treatment with an anterior-approach corpectomy, tumor resection, and fusion, while the rest took the back door with a posterior approach. And guess what? Everyone who stuck around for at least a year managed to fuse their bones together. Only a couple of party fouls were reported: one CSF leak and a new-onset neurological deficit.

So, what have we learned from this epic saga? Well, if your kid’s spine is a bit out of whack, has had a significant chunk of bone removed, or looks like it’s been through a paper shredder, maybe, just maybe, consider throwing in a fusion during the first surgery. But hey, don’t take my word for it. The literature is as sparse as a balding man’s comb-over, so we definitely need more data before making this the go-to move. Until then, let’s keep our spines straight and our sarcasm sharper.