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Prediction of Curve Progression After Posterior Fossa Decompression in Pediatric Patients With Scoliosis Secondary to Chiari Malformation

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Abstract

Objective

In this retrospective radiographic and clinical study, we analyzed the evolution of scoliosis after posterior fossa decompression (PFD) to determine the predictors of curve progression after PFD in patients with scoliosis secondary to Chiari malformation type I (CM-I) and syringomyelia (SM). Institutional Review Board approval was obtained to conduct the study. Previous studies have shown that PFD can improve the associated scoliosis in some patients with CM-I, and certain clinical factors can predict curve progression after PFD. However, the results were often contradictory.

Methods

In our study, 54 patients with CM-I who underwent a standard PFD were divided into 2 groups according to the evolution of scoliosis after PFD. One group consisted of “progressors” with curve progression of more than 5° from before PFD to the final follow-up; the other group consisted of “nonprogressors” with curve stabilization or improvement. Clinical and radiographic data were compared between progressors and nonprogressors.

Results

Twenty-five of the patients received brace treatment, and 11 patients underwent spinal fusion. Nineteen patients were identified as progressors, and 35 were nonprogressors. Age, curve type, curve magnitude, and bracing treatment were independent predictors for curve progression after PFD. Both an age ≥ 10.5 years and a Cobb angle ≥ 44.5° were strongly predictive factors for curve progression. Regarding those patients with an indication for bracing, a significant difference (p=.009) was noted in terms of the evolution of scoliosis between patients with and without bracing treatment.

Conclusion

PFD had an effect on the regression of scoliosis in 64.8% of the CM-I patients. An age ≥ 10.5 years, a Cobb angle ≥ 44.5°, and double curves were factors that could predict the progression of scoliosis in these patients. Additionally, we advocate that bracing treatment may be effective in some skeletally immature patients.

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Authors and Affiliations

  1. Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China

    Zezhang Zhu MD, Tao Wu PhD, Song Zhou PhD, Xu Sun MD, Huang Yan MD, Shifu Sha PhD & Yong Qiu MD

Authors
  1. Zezhang Zhu MD
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  2. Tao Wu PhD
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  3. Song Zhou PhD
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  4. Xu Sun MD
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  5. Huang Yan MD
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  6. Shifu Sha PhD
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  7. Yong Qiu MD
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Corresponding author

Correspondence to Yong Qiu MD.

Additional information

Author disclosures: ZZ (grant from the National Natural Science Foundation of China); TW (none); SZ (none); XS (none); HY (none); SS (none); YQ (none).

This work is supported by Grant No. 81171672 of the National Natural Science Foundation of China (ZZ).

The first 2 authors contributed equally to this work.

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Zhu, Z., Wu, T., Zhou, S. et al. Prediction of Curve Progression After Posterior Fossa Decompression in Pediatric Patients With Scoliosis Secondary to Chiari Malformation. Spine Deform 1, 25–32 (2013). https://doi.org/10.1016/j.jspd.2012.07.005

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  • DOI: https://doi.org/10.1016/j.jspd.2012.07.005

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