Skip to main content

Brace treatment for scoliosis secondary to chiari malformation type 1 or syringomyelia without neurosurgical intervention: A matched comparison with idiopathic scoliosis

European Spine Journal volume 30, pages 3482–3489 (2021)Cite this article

Abstract

Purpose

To evaluate the effectiveness of brace treatment in patients with Chiari malformation type 1 (CM-1) or syringomyelia associated scoliosis without neurosurgical intervention.

Methods

This was a retrospective case–control study. 34 CM-1 or syringomyelia (CMS) patients who received brace treatment without neurosurgical intervention were recruited. Another 68 matched patients with idiopathic scoliosis who received bracing served as the control group. The matching criteria included gender, age (± 1 years), Risser sign (± 1 grade), initial curve magnitude (± 5°), curve patterns and follow-up time (± 6 months). Patients who encountered curve progression and scoliosis surgery were compared between different groups.

Results

Until the last visit, 16 (47%) patients in CMS group and 18 (26%) patients in IS group occurred curve progression; 9 (26%) patients and 15 (22%) patients underwent scoliosis surgery, respectively. Compared to idiopathic scoliosis, patients with CMS-associated scoliosis had a significantly higher rate of curve progression (P = 0.038). However, no significant difference was observed between two groups regarding to the rate of surgery (P = 0.867). Patients with combined CM-1 and syringomyelia had a higher rate of surgery than patients with isolated CM-1 or syringomyelia (P = 0.049). The double major curve pattern was identified as the risk factor for curve progression.

Conclusion

Brace treatment is effective for CMS-associated scoliosis without neurosurgical intervention. Compared to idiopathic scoliosis, brace can provide similar prevention for scoliosis surgery in CMS patients, but slight or moderate curve progression may occur. Specifically, patients with combined CM-1 and syringomyelia should be followed closely with a higher expectation of curve progression.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Weinstein S, Dolan L, Wright J, Dobbs M (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521. https://doi.org/10.1056/NEJMoa1307337

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Sponseller P, Bhimani M, Solacoff D, Dormans J (2000) Results of brace treatment of scoliosis in Marfan syndrome. Spine 25(18):2350–2354

    CAS  Article  Google Scholar 

  3. Wang Y, Feng Z, Wu Z, Qiu Y, Zhu Z, Xu L (2019) Brace treatment can serve as a time-buying tactic for patients with congenital scoliosis. J Orthop Surg Res 14(1):194. https://doi.org/10.1186/s13018-019-1244-4

    Article  PubMed  PubMed Central  Google Scholar 

  4. Eule J, Erickson M, O’Brien M, Handler M (2002) Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population. Spine. https://doi.org/10.1097/00007632-200207010-00015

    Article  PubMed  Google Scholar 

  5. Ravindra V, Onwuzulike K, Heller R, Quigley R, Smith J, Dailey A, Brockmeyer D (2018) Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction. J Neurosurg Pediatr 21(2):185–189. https://doi.org/10.3171/2017.8.Peds17318

    Article  PubMed  Google Scholar 

  6. Strahle J, Muraszko K, Kapurch J, Bapuraj J, Garton H, Maher C (2011) Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr 8(2):205–213. https://doi.org/10.3171/2011.5.Peds1121

    Article  PubMed  Google Scholar 

  7. Strahle J, Smith B, Martinez M, Bapuraj J, Muraszko K, Garton H, Maher C (2015) The association between Chiari malformation Type I, spinal syrinx, and scoliosis. J Neurosurg Pediatr 15(6):607–611. https://doi.org/10.3171/2014.11.Peds14135

    Article  PubMed  Google Scholar 

  8. Tubbs R, Beckman J, Naftel R, Chern J, Wellons J, Rozzelle C, Blount J, Oakes W (2011) Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr 7(3):248–256. https://doi.org/10.3171/2010.12.Peds10379

    Article  PubMed  Google Scholar 

  9. Tubbs R, McGirt M, Oakes W (2003) Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99(2):291–296. https://doi.org/10.3171/jns.2003.99.2.0291

    Article  PubMed  Google Scholar 

  10. Batzdorf U, Khoo L, McArthur D (2007) Observations on spine deformity and syringomyelia. Neurosurgery. https://doi.org/10.1227/01.Neu.0000279971.87437.1f

    Article  PubMed  Google Scholar 

  11. Zhu Z, Sha S, Chu W, Yan H, Xie D, Liu Z, Sun X, Zhu W, Cheng J, Qiu Y (2016) Comparison of the scoliosis curve patterns and MRI syrinx cord characteristics of idiopathic syringomyelia versus Chiari I malformation. Eur Spine J 25(2):517–525. https://doi.org/10.1007/s00586-015-4108-6

    Article  PubMed  Google Scholar 

  12. Sha S, Zhu Z, Sun X, Zheng X, Liu Z, Wu T, Yan H, Qiu Y (2013) Effectiveness of brace treatment of Chiari malformation-associated scoliosis after posterior fossa decompression: a comparison with idiopathic scoliosis. Spine 38(5):E299–E305

    Article  Google Scholar 

  13. Sha S, Zhu Z, Lam T, Sun X, Qian B, Jiang J, Cheng J, Qiu Y (2014) Brace treatment versus observation alone for scoliosis associated with Chiari I malformation following posterior fossa decompression: a cohort study of 54 patients. Eur Spine J 23(6):1224–1231. https://doi.org/10.1007/s00586-014-3265-3

    Article  PubMed  Google Scholar 

  14. Qiu Y, Sun X, Cheng JC, Zhu F, Li W, Zhu Z, Wang B, Yu Y (2008) Bone mineral accrual in osteopenic and non-osteopenic girls with idiopathic scoliosis during bracing treatment. Spine. https://doi.org/10.1097/BRS.0b013e31817b5b9e

    Article  PubMed  Google Scholar 

  15. Wiley J, Thomson J, Mitchell T, Smith B, Banta J (2000) Effectiveness of the boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine. https://doi.org/10.1097/00007632-200009150-00010

    Article  PubMed  Google Scholar 

  16. Katz D, Durrani A (2001) Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine 26(21):2354–2361

    CAS  Article  Google Scholar 

  17. Aboulezz A, Sartor K, Geyer C, Gado M (1985) Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 9(6):1033–1036. https://doi.org/10.1097/00004728-198511000-00005

    CAS  Article  PubMed  Google Scholar 

  18. Haroun R, Guarnieri M, Meadow J, Kraut M, Carson B (2000) Current opinions for the treatment of syringomyelia and chiari malformations: survey of the Pediatric Section of the American Association of Neurological Surgeons. Pediatr Neurosurg 33(6):311–317. https://doi.org/10.1159/000055977

    CAS  Article  PubMed  Google Scholar 

  19. Singhal A, Cheong A, Steinbok P (2018) International survey on the management of Chiari 1 malformation and syringomyelia: evolving worldwide opinions. Childs Nerv Syst 34(6):1177–1182. https://doi.org/10.1007/s00381-018-3741-x

    Article  PubMed  Google Scholar 

  20. Pomeraniec I, Ksendzovsky A, Awad A, Fezeu F, Jane J (2016) Natural and surgical history of Chiari malformation Type I in the pediatric population. J Neurosurg Pediatr 17(3):343–352. https://doi.org/10.3171/2015.7.Peds1594

    Article  PubMed  Google Scholar 

  21. Whitson W, Lane J, Bauer D, Durham S (2015) A prospective natural history study of nonoperatively managed Chiari I malformation: does follow-up MRI surveillance alter surgical decision making? J Neurosurg Pediatr 16(2):159–166. https://doi.org/10.3171/2014.12.Peds14301

    Article  PubMed  Google Scholar 

  22. Nishizawa S, Yokoyama T, Yokota N, Tokuyama T, Ohta S (2001) Incidentally identified syringomyelia associated with Chiari I malformations: is early interventional surgery necessary? Neurosurgery. https://doi.org/10.1097/00006123-200109000-00018

    Article  PubMed  Google Scholar 

  23. Akhtar O, Rowe D (2008) Syringomyelia-associated scoliosis with and without the Chiari I malformation. J Am Acad Orthop Surg 16(7):407–417. https://doi.org/10.5435/00124635-200807000-00006

    Article  PubMed  Google Scholar 

  24. Charry O, Koop S, Winter R, Lonstein J, Denis F, Bailey W (1994) Syringomyelia and scoliosis: a review of twenty-five pediatric patients. J Pediatr Orthop 14(3):309–317. https://doi.org/10.1097/01241398-199405000-00007

    CAS  Article  PubMed  Google Scholar 

  25. Tokunaga M, Minami S, Isobe K, Moriya H, Kitahara H, Nakata Y (2001) Natural history of scoliosis in children with syringomyelia. J Bone Joint Surg Br 83(3):371–376. https://doi.org/10.1302/0301-620x.83b3.11021

    CAS  Article  PubMed  Google Scholar 

  26. Godzik J, Holekamp T, Limbrick D, Lenke L, Park T, Ray W, Bridwell K, Kelly M (2015) Risks and outcomes of spinal deformity surgery in Chiari malformation, Type 1, with syringomyelia versus adolescent idiopathic scoliosis. Spine J 15(9):2002–2008. https://doi.org/10.1016/j.spinee.2015.04.048

    Article  PubMed  PubMed Central  Google Scholar 

  27. Godzik J, Dardas A, Kelly M, Holekamp T, Lenke L, Smyth M, Park T, Leonard J, Limbrick D (2016) Comparison of spinal deformity in children with Chiari I malformation with and without syringomyelia: matched cohort study. Eur Spine J 25(2):619–626. https://doi.org/10.1007/s00586-015-4011-1

    CAS  Article  PubMed  Google Scholar 

  28. Yan H, Han X, Jin M, Liu Z, Xie D, Sha S, Qiu Y, Zhu Z (2016) Morphometric features of posterior cranial fossa are different between Chiari I malformation with and without syringomyelia. Eur Spine J 25(7):2202–2209. https://doi.org/10.1007/s00586-016-4410-y

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Jiangsu Provincial Key Medical Center (Grant No. YXZXA2016009) and the National Natural Science Foundation of China (Grant No. 81772304).

Author information

Authors and Affiliations

  1. Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China

    Tianyuan Zhang, Hongda Bao, Xin Zhang, Shibin Shu, Zhen Liu, Xu Sun, Yong Qiu & Zezhang Zhu

Authors
  1. Tianyuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongda Bao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shibin Shu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xu Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zezhang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zezhang Zhu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

The manuscript submitted does not contain information about medical device/drug(s).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, T., Bao, H., Zhang, X. et al. Brace treatment for scoliosis secondary to chiari malformation type 1 or syringomyelia without neurosurgical intervention: A matched comparison with idiopathic scoliosis. Eur Spine J 30, 3482–3489 (2021). https://doi.org/10.1007/s00586-021-06958-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06958-2

Keywords

  • Brace treatment
  • Chiari malformation
  • Curve progression
  • Scoliosis
  • Syringomyelia