Abstract
Priority of neurological decompression was regarded as necessary for scoliosis patients associated with Chiari I malformation in order to decrease the risk of spinal cord injury from scoliosis surgery. We report a retrospective series of scoliosis associated with Chiari I malformation in 13 adolescent patients and explore the effectiveness and safety of posterior scoliosis correction without suboccipital decompression. One-stage posterior approach total vertebral column resection was performed in seven patients with scoliosis or kyphosis curve >90° (average 100.1° scoliotic and 97.1° kyphotic curves) or presented with apparent neurological deficits, whereas the other six patients underwent posterior pedicle screw instrumentation for correction of spinal deformity alone (average 77.3° scoliotic and 44.0° kyphotic curves). The apex of the scoliosis curve was located at T7–T12. Mean operating time and intraoperative hemorrhage was 463 min and 5,190 ml in patients undergoing total vertebral column resection, with average correction rate of scoliosis and kyphosis being 63.3 and 71.1%, respectively. Mean operating time and intraoperative hemorrhage in patients undergoing instrumentation alone was 246 min and 1,450 ml, with the average correction rate of scoliosis and kyphosis being 60.8 and 53.4%, respectively. The mean follow-up duration was 32.2 months. No iatrogenic neurological deterioration had been encountered during the operation procedure and follow-up. After vertebral column resection, neurological dysfunctions such as relaxation of anal sphincter or hypermyotonia that occurred in three patients preoperatively improved gradually. In summary, suboccipital decompression prior to correction of spine deformity may not always be necessary for adolescent patients with scoliosis associated with Chiari I malformation. Particularly in patients with a severe and rigid curve or with significant neurological deficits, posterior approach total vertebral column resection is likely a good option, which could not only result in satisfactory correction of deformity, but also decrease the risk of neurological injury secondary to surgical intervention by shortening spine and reducing the tension of spinal cord.
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References
Akhtar OH, Rowe DE (2008) Syringomyelia-associated scoliosis with and without the Chiari I malformation. J Am Acad Orthop Surg 16:407–417
Bhangoo R, Sgouros S (2006) Scoliosis in children with Chiari I-related syringomyelia. Childs Nerv Syst 22:1154–1157
Bradley LJ, Ratahi ED, Crawford HA, Barnes MJ (2007) The outcomes of scoliosis surgery in patients with syringomyelia. Spine (Phila Pa 1976) 32:2327–2333
Bridwell KH, Lewis S, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 86(Suppl 1):44–50
Brockmeyer D, Gollogly S, Smith JT (2003) Scoliosis associated with Chiari I malformations: the effect of suboccipital decompression on scoliosis curve progression: a preliminary study. Spine 28:2505–2509
Cardoso M, Keating RF (2009) Neurosurgical management of spinal dysraphism and neurogenic scoliosis. Spine (Phila Pa 1976) 34:1775–1782
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 Othop 14:309–317
Eule JM, Erickson MA, O’Brien MF, 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 (Phila Pa 1976) 27:1451–1455
Farley FA, Song KM, Birch JG, Browne R (1995) Syringomyelia and scoliosis in children. J Pediatr Orthop 15:187–192
Flynn JM, Sodha S, Lou JE, Adams SB Jr, Whitfield B, Ecker ML, Sutton L, Dormans JP, Drummond DS (2004) Predictors of progression of scoliosis after decompression of an Arnold Chiari I malformation. Spine (Phila Pa 1976) 29:286–292
Hankinson TC, Klimo P Jr, Feldstein NA, Anderson RC, Brockmeyer D (2007) Chiari malformations, syringohydromyelia and scoliosis. Neurosurg Clin N Am 18:549–568
Haroun RI, Guarnieri M, Meadow JJ, Kraut M, Carson BS (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 33:311–317
Kawahara N, Tomita K, Kobayashi T, Abdel-Wanis ME, Murakami H, Akamaru T (2005) Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976) 30:613–620
Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976) 34:2213–2221
Lo YL, Dan YF, Tan YE, Nurjannah S, Tan SB, Tan CT, Raman S (2006) Intraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens. J Neurosurg Anesthesiol 18:211–214
Ono A, Ueyama K, Okada A, Echigoya N, Yokoyama T, Harata S (2002) Adult scoliosis in syringomyelia associated with Chiari I malformation. Spine (Phila Pa 1976) 27:E23–E28
Qiu Y, Wang B, Zhu ZZ, Lv JY, Yu Y, Zhu LH (2003) Clinical manifestation and treatment strategy of scoliosis associated with Chiari malformation and/or syringomyelia. Chin J of Orthopaedics 23:564–567
Schlesinger EB, Antunes JL, Michelsen WJ, Louis KM (1981) Hydromyelia: clinical presentation and comparison of modalities of treatment. Neurosurgery 9:356–365
Sengupta DK, Dorgan J, Findlay GF (2000) Can hindbrain decompression for syringomyelia lead to regression of scoliosis? Eur Spine J 9:198–201
Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30:1682–1687
Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27:2374–2382
Tomlinson RJ Jr, Wolfe MW, Nadall JM, Bennett JT, MacEwen GD (1994) Syringomyelia and developmental scoliosis. J Pediatr Othop 14:580–585
Tubbs RS, Doyle S, Conclin M, Oakes WJ (2006) Scoliosis in a child with Chiari I malformation and the absence of syringomyelia: case report and a review of the literature. Childs Nerv Syst 22:1351–1354
Zhu ZZ, Qiu Y, Wang B, Yu Y, Qian B, Zhu F (2007) Abnormal spreading and subunit expression of junctional acetylcholine receptors of paraspinal muscles in scoliosis associated with syringomyelia. Spine (Phila Pa 1976) 32:2449–2454
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Xie, J., Wang, Y., Zhao, Z. et al. One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?. Eur Spine J 20, 1106–1113 (2011). https://doi.org/10.1007/s00586-011-1717-6
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DOI: https://doi.org/10.1007/s00586-011-1717-6