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Naessig S, Tretiakov P, Patel K, Ahmad W, Pierce K, Kummer N, Joujon-Roche R, Imbo B, Williamson T, Krol O, Janjua MB, Vira S, Diebo B, Sciubba D, Passias P. Concurrent Presence of Thoracolumbar Scoliosis and Chiari Malformation: Is Operative Risk Magnified? Asian Spine J 2023; 17:703-711. [PMID: 37226444 PMCID: PMC10460654 DOI: 10.31616/asj.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 05/26/2023] Open
Abstract
STUDY DESIGN Retrospective review of Kids' Inpatient Database (KID). PURPOSE Identify the risks and complications associated with surgery in adolescents diagnosed with Chiari and scoliosis. OVERVIEW OF LITERATURE Scoliosis is frequently associated with Chiari malformation (CM). More specifically, reports have been made about this association with CM type I in the absence of syrinx status. METHODS The KID was used to identify all pediatric inpatients with CM and scoliosis. The patients were stratified into three groups: those with concomitant CM and scoliosis (CMS group), those with only CM (CM group), and those with only scoliosis (Sc group). Multivariate logistic regressions were used to assess association between surgical characteristics and diagnosis with complication rate. RESULTS A total of 90,707 spine patients were identified (61.8% Sc, 37% CM, 1.2% CMS). Sc patients were older, had a higher invasiveness score, and higher Charlson comorbidity index (all p<0.001). CMS patients had significantly higher rates of surgical decompression (36.7%). Sc patients had significantly higher rates of fusions (35.3%) and osteotomies (1.2%, all p<0.001). Controlling for age and invasiveness, postoperative complications were significantly associated with spine fusion surgery for Sc patients (odds ratio [OR], 1.8; p<0.05). Specifically, posterior spinal fusion in the thoracolumbar region had a greater risk of complications (OR, 4.9) than an anterior approach (OR, 3.6; all p<0.001). CM patients had a significant risk of complications when an osteotomy was performed as part of their surgery (OR, 2.9) and if a spinal fusion was concurrently performed (OR, 1.8; all p<0.05). Patients in the CMS cohort were significantly likely to develop postoperative complications if they underwent a spinal fusion from both anterior (OR, 2.5) and posterior approach (OR, 2.7; all p<0.001). CONCLUSIONS Having concurrent scoliosis and CM increases operative risk for fusion surgeries despite approach. Being independently inflicted with scoliosis or Chiari leads to increased complication rate when paired with thoracolumbar fusion and osteotomies; respectively.
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Affiliation(s)
- Sara Naessig
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Peter Tretiakov
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Karan Patel
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Waleed Ahmad
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Katherine Pierce
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Nicholas Kummer
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Rachel Joujon-Roche
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Bailey Imbo
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Tyler Williamson
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | - Oscar Krol
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
| | | | - Shaleen Vira
- Department of Orthopaedic Surgery and Neurosurgery, UT Southwestern Medical Center, Dallas, TX,
USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, NY,
USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Peter Passias
- Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY,
USA
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Shanmugasundaram S, Viswanathan VK, Shetty AP, Rai N, Hajare S, Kanna RM, Rajasekaran S. Type I Arnold Chiari Malformation with Syringomyelia and Scoliosis: Radiological Correlations between Tonsillar Descent, Syrinx Morphology and Curve Characteristics: A Retrospective Study. Asian Spine J 2023; 17:156-165. [PMID: 35785912 PMCID: PMC9977991 DOI: 10.31616/asj.2021.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. PURPOSE The current study was planned to evaluate deformity characteristics, assess relationship between morphology of syrinx/Arnold Chiari malformation (ACM) and deformity, analyze effect of posterior fossa decompression (PFD), and evaluate outcome. OVERVIEW OF LITERATURE Scoliosis in ACM-I and syringomyelia (SM) is uncommon, and deformity characteristics differ from those seen in idiopathic scoliosis. METHODS Data regarding patients, who underwent PFD for ACM-I presenting with SM and scoliosis between January 2009 and December 2018, were retrospectively collected. Only patients with 2-year follow-up were included. Sagittal/coronal deformity and sagittal spinopelvic parameters were examined. Symmetry and extent of tonsillar descent, as well as morphology (configuration/variation) and extent of syrinx were determined. RESULTS A total of 42 patients (20 females; age: 14.2±5.8 years) were included; 35 patients (83.3%) had atypical curves. Mean preoperative coronal Cobb was 57.7°±20.9°; and 12 (28.6%) had significant coronal imbalance. Tonsillar descent was classified as grade 1, 2, and 3 in 16 (38.1%), 11 (26.2%), and 15 (35.7%) patients; 35 patients (83.3%) had asymmetric tonsillar descent; 17 (40.4%), 3 (7.1%), 16 (38.1%), and 6 (14.4%) had circumscribed, moniliform, dilated, and slender syrinx patterns; and 9 (21.4%), 12 (28.6%), and 21 (50%) of syrinx were right-sided, left-sided, and centric. There was no significant relationship between side of tonsillar dominance (p =0.31), grade of descent (p =0.30), and convexity of deformity. There was significant association between side of syrinx and convexity of scoliosis (p =0.01). PFD was performed in all, and deformity correction was performed in 23 patients. In curves ≤40°, PFD alone could stabilize scoliosis progression (p =0.02). There was significant reduction in syrinx/cord ratio following PFD (p <0.001). CONCLUSIONS ACM-I+SM patients had atypical curve patterns in 83% of cases, and the side of syrinx deviation correlates with scoliosis convexity. Syrinx shrinks significantly following PFD. PFD may not stabilize scoliosis in curves >40°.
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Affiliation(s)
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Center and Hospital, Coimbatore,
India
| | - Nimish Rai
- Department of Spine Surgery, Ganga Medical Center and Hospital, Coimbatore,
India
| | - Swapnil Hajare
- Department of Spine Surgery, Ganga Medical Center and Hospital, Coimbatore,
India
| | - Rishi Mukesh Kanna
- Department of Spine Surgery, Ganga Medical Center and Hospital, Coimbatore,
India
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Sadler B, Skidmore A, Gewirtz J, Anderson RCE, Haller G, Ackerman LL, Adelson PD, Ahmed R, Albert GW, Aldana PR, Alden TD, Averill C, Baird LC, Bauer DF, Bethel-Anderson T, Bierbrauer KS, Bonfield CM, Brockmeyer DL, Chern JJ, Couture DE, Daniels DJ, Dlouhy BJ, Durham SR, Ellenbogen RG, Eskandari R, Fuchs HE, George TM, Grant GA, Graupman PC, Greene S, Greenfield JP, Gross NL, Guillaume DJ, Hankinson TC, Heuer GG, Iantosca M, Iskandar BJ, Jackson EM, Jea AH, Johnston JM, Keating RF, Khan N, Krieger MD, Leonard JR, Maher CO, Mangano FT, Mapstone TB, McComb JG, McEvoy SD, Meehan T, Menezes AH, Muhlbauer M, Oakes WJ, Olavarria G, O'Neill BR, Ragheb J, Selden NR, Shah MN, Shannon CN, Smith J, Smyth MD, Stone SSD, Tuite GF, Wait SD, Wellons JC, Whitehead WE, Park TS, Limbrick DD, Strahle JM. Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 2021; 28:167-175. [PMID: 34144521 DOI: 10.3171/2020.12.peds20552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.
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Affiliation(s)
- Brooke Sadler
- 1Department of Pediatrics, Washington University in St. Louis, MO
| | - Alex Skidmore
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jordan Gewirtz
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Gabe Haller
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Laurie L Ackerman
- 4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - P David Adelson
- 5Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Raheel Ahmed
- 6Department of Neurological Surgery, University of Wisconsin at Madison, WI
| | - Gregory W Albert
- 7Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR
| | - Philipp R Aldana
- 8Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FL
| | - Tord D Alden
- 9Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, IL
| | - Christine Averill
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Lissa C Baird
- 10Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
| | - David F Bauer
- 11Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX
| | - Tammy Bethel-Anderson
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Karin S Bierbrauer
- 12Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Christopher M Bonfield
- 43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN
| | - Douglas L Brockmeyer
- 13Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT
| | - Joshua J Chern
- 14Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta, GA
| | - Daniel E Couture
- 15Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Brian J Dlouhy
- 39Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Susan R Durham
- 18Department of Neurosurgery, University of Vermont, Burlington, VT
| | | | - Ramin Eskandari
- 20Department of Neurosurgery, Medical University of South Carolina, Charleston, SC
| | | | - Timothy M George
- 22Division of Pediatric Neurosurgery, Dell Children's Medical Center, Austin, TX
| | - Gerald A Grant
- 23Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital and Stanford University School of Medicine, Palo Alto, CA
| | - Patrick C Graupman
- 24Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, MN
| | - Stephanie Greene
- 25Division of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jeffrey P Greenfield
- 26Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY
| | - Naina L Gross
- 27Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK
| | - Daniel J Guillaume
- 28Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN
| | - Todd C Hankinson
- 29Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO
| | - Gregory G Heuer
- 30Division of Pediatric Neurosurgery, Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark Iantosca
- 31Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Bermans J Iskandar
- 6Department of Neurological Surgery, University of Wisconsin at Madison, WI
| | - Eric M Jackson
- 32Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew H Jea
- 4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - James M Johnston
- 33Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL
| | - Robert F Keating
- 34Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Nickalus Khan
- 36Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TN
| | - Mark D Krieger
- 37Department of Neurosurgery, Children's Hospital Los Angeles, CA
| | - Jeffrey R Leonard
- 38Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH
| | - Cormac O Maher
- 3Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, MI
| | - Francesco T Mangano
- 12Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OH
| | | | - J Gordon McComb
- 37Department of Neurosurgery, Children's Hospital Los Angeles, CA
| | - Sean D McEvoy
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Thanda Meehan
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Arnold H Menezes
- 39Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Michael Muhlbauer
- 36Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TN
| | - W Jerry Oakes
- 33Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL
| | - Greg Olavarria
- 40Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL
| | - Brent R O'Neill
- 29Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO
| | - John Ragheb
- 41Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL
| | - Nathan R Selden
- 10Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
| | - Manish N Shah
- 42Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TX
| | - Chevis N Shannon
- 43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN
- 47Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN
| | - Jodi Smith
- 4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew D Smyth
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Scellig S D Stone
- 44Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, MA
| | - Gerald F Tuite
- 45Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, FL
| | - Scott D Wait
- 46Carolina Neurosurgery & Spine Associates, Charlotte, NC; and
| | - John C Wellons
- 43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN
- 47Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN
| | - William E Whitehead
- 11Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX
| | - Tae Sung Park
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - David D Limbrick
- 1Department of Pediatrics, Washington University in St. Louis, MO
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jennifer M Strahle
- 1Department of Pediatrics, Washington University in St. Louis, MO
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
- 35Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
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Mohanty SP, Kanhangad MP, Saifuddin S, Narayana Kurup JK. Pattern of Syringomyelia in Presumed Idiopathic and Congenital Scoliosis. Asian Spine J 2020; 15:791-798. [PMID: 33189109 PMCID: PMC8696068 DOI: 10.31616/asj.2020.0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022] Open
Abstract
Study Design Retrospective study. Purpose This study was undertaken to compare the patterns of syringomyelia in patients with presumed idiopathic and congenital scoliosis. Overview of Literature The incidence of neuraxial anomalies presenting as idiopathic scoliosis ranges from 2% to 14%; the common ones are idiopathic syringomyelia (IS) and Chiari malformation type 1 (CM1) with syringomyelia. Some authors have speculated that scoliosis is caused by the asymmetrical compression of anterior horn cells by a syrinx, which causes an imbalance of the trunk musculature. In congenital scoliosis, syringomyelia is the second commonest cord anomaly, and the deformity progression depends upon the underlying vertebral abnormality, the location of the abnormality, and the age of patient, and is independent of the intraspinal anomaly. Methods We analyzed the radiological records of 44 consecutive patients with scoliosis and syringomyelia. Of these 44 patients, 13 had IS, 12 had CM1, and 19 had congenital scoliosis. The radiographs were evaluated to determine the curve magnitude, sagittal alignment, side of convexity, and type of vertebral anomaly, if any. T1- and T2-weighted magnetic resonance imaging of the whole spine was analyzed to determine the presence of craniovertebral anomalies, syrinx length, syrinx diameter, and syrinx-cord ratio (SCR). Results The frequency of left convex curves was 26.1%, with no significant differences across the three groups. The mean length of the syrinx was 7.2±4.9 vertebral levels, and the mean SCR was 0.39±0.2. The mean syrinx length was significantly higher in patients with CM1 and IS, compared to patients with congenital scoliosis. The mean SCR was highest in patients with CM1. In congenital scoliosis, syringomyelia was seen most frequently in patients with a failure of formation, and 63.2% had concomitant cord anomalies. Conclusions Syrinxes were smaller in size and length in patients with congenital scoliosis, and are distinct from those seen in IS and CM1.
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Affiliation(s)
- Simanchal Prosad Mohanty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Madhava Pai Kanhangad
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sibin Saifuddin
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Abstract
BACKGROUND The association of scoliosis and congenital limb deficiency has been well described. However, the incidence of neural axis abnormalities in this population is not known. The ability to assess the neural axis by physical examination may be limited in patients with a limb deficiency. Although mobility of the spine is important for all children, it can be especially so in children with a limb deficiency. As spinal fusion in children with limb deficiency potentially has more functional impact, detecting reversible forms of scoliosis seems particularly important. METHODS Retrospective review of children treated at 1 institution between 1990 and 2017 with both a diagnosis of a congenital limb deficiency, upper or lower, and scoliosis. Children were excluded if they had any neurological difference on history or physical examination, if they had sacral agenesis or spina bifida, or if their limb deficiency was related to trauma or early amniotic rupture sequence. RESULTS Twenty-four children were identified, 11 with lower extremity deficiency, 14 with upper extremity deficiency with 1 having both. Fifteen children demonstrated neural axis abnormalities, 6 (40%) required neurosurgery. Five (45%) of 11 lower extremity deficiency children had MRI findings, 3 of these needing neurosurgery. Of the 14 upper extremity deficiency children, 10 had MRI changes, and 3 required neurosurgery. Eight children with congenital scoliosis, 5 had MRI findings, with 4 children requiring neurosurgery. The other 16 children had scoliosis without vertebral abnormalities, 10 had MRI findings, and 2 required neurosurgery. CONCLUSIONS There is a high incidence of neural axis abnormalities (63%) in children with congenital limb deficiencies and scoliosis. A large portion of these require neurosurgical intervention. MRI should be considered soon after presentation in this population of children. LEVEL OF EVIDENCE Level IV. DESIGN Retrospective cohort.
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Horn SR, Shepard N, Vasquez-Montes D, Bortz CA, Segreto FA, De La Garza Ramos R, Goodwin CR, Passias PG. Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type. J Clin Neurosci 2018; 58:165-171. [DOI: 10.1016/j.jocn.2018.06.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
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Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study. World Neurosurg 2018; 110:e465-e472. [DOI: 10.1016/j.wneu.2017.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 11/18/2022]
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Ravindra VM, Onwuzulike K, Heller RS, Quigley R, Smith J, Dailey AT, Brockmeyer DL. Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction. J Neurosurg Pediatr 2018; 21:185-189. [PMID: 29171800 DOI: 10.3171/2017.8.peds17318] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous reports have addressed the short-term response of patients with Chiari-related scoliosis (CRS) to suboccipital decompression and duraplasty (SODD); however, the long-term behavior of the curve has not been well defined. The authors undertook a longitudinal study of a cohort of patients who underwent SODD for CRS to determine whether there are factors related to Chiari malformation (CM) that predict long-term scoliotic curve behavior and need for deformity correction. METHODS The authors retrospectively reviewed cases in which patients underwent SODD for CRS during a 14-year period at a single center. Clinical (age, sex, and associated disorders/syndromes) and radiographic (CM type, tonsillar descent, pBC2 line, clival-axial angle [CXA], syrinx length and level, and initial Cobb angle) information was evaluated to identify associations with the primary outcome: delayed thoracolumbar fusion for progressive scoliosis. RESULTS Twenty-eight patients were identified, but 4 were lost to follow-up and 1 underwent fusion within a year. Among the remaining 23 patients, 11 required fusion surgery at an average of 88.3 ± 15.4 months after SODD, including 7 (30%) who needed fusion more than 5 years after SODD. On univariate analysis, a lower CXA (131.5° ± 4.8° vs 146.5° ± 4.6°, p = 0.034), pBC2 > 9 mm (64% vs 25%, p = 0.06), and higher initial Cobb angle (35.1° ± 3.6° vs 22.8° ± 4.0°, p = 0.035) were associated with the need for thoracolumbar fusion. Multivariable modeling revealed that lower CXA was independently associated with a need for delayed thoracolumbar fusion (OR 1.12, p = 0.0128). CONCLUSIONS This investigation demonstrates the long-term outcome and natural history of CRS after SODD. The durability of the effect of SODD on CRS and curve behavior is poor, with late curve progression occurring in 30% of patients. Factors associated with CRS progression include an initial pBC2 > 9 mm, lower CXA, and higher Cobb angle. Lower CXA was an independent predictor of delayed thoracolumbar fusion. Further study is necessary on a larger cohort of patients to fully elucidate this relationship.
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Affiliation(s)
- Vijay M Ravindra
- 1Department of Neurosurgery, University of Utah, Primary Children's Hospital
| | - Kaine Onwuzulike
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Robert S Heller
- 3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Robert Quigley
- 4Department of Orthopedic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - John Smith
- 4Department of Orthopedic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Andrew T Dailey
- 1Department of Neurosurgery, University of Utah, Primary Children's Hospital
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Mackel CE, Cahill PJ, Roguski M, Samdani AF, Sugrue PA, Kawakami N, Sturm PF, Pahys JM, Betz RR, El-Hawary R, Hwang SW. Factors associated with spinal fusion after posterior fossa decompression in pediatric patients with Chiari I malformation and scoliosis. J Neurosurg Pediatr 2016; 25:737-743. [PMID: 27589598 DOI: 10.3171/2016.5.peds16180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors performed a study to identify clinical characteristics of pediatric patients diagnosed with Chiari I malformation and scoliosis associated with a need for spinal fusion after posterior fossa decompression when managing the scoliotic curve. METHODS The authors conducted a multicenter retrospective review of 44 patients, aged 18 years or younger, diagnosed with Chiari I malformation and scoliosis who underwent posterior fossa decompression from 2000 to 2010. The outcome of interest was the need for spinal fusion after decompression. RESULTS Overall, 18 patients (40%) underwent posterior fossa decompression alone, and 26 patients (60%) required a spinal fusion after the decompression. The mean Cobb angle at presentation and the proportion of patients with curves > 35° differed between the decompression-only and fusion cohorts (30.7° ± 11.8° vs 52.1° ± 26.3°, p = 0.002; 5 of 18 vs 17 of 26, p = 0.031). An odds ratio of 1.0625 favoring a need for fusion was established for each 1° of increase in Cobb angle (p = 0.012, OR 1.0625, 95% CI 1.0135-1.1138). Among the 14 patients older than 10 years of age with a primary Cobb angle exceeding 35°, 13 (93%) ultimately required fusion. Patients with at least 1 year of follow-up whose curves progressed more 10° after decompression were younger than those without curve progression (6.1 ± 3.0 years vs 13.7 ± 3.2 years, p = 0.001, Mann-Whitney U-test). Left apical thoracic curves constituted a higher proportion of curves in the decompression-only group (8 of 16 vs 1 of 21, p = 0.002). CONCLUSIONS The need for fusion after posterior fossa decompression reflected the curve severity at clinical presentation. Patients presenting with curves measuring > 35°, as well as those greater than 10 years of age, may be at greater risk for requiring fusion after posterior fossa decompression, while patients less than 10 years of age may require routine monitoring for curve progression. Left apical thoracic curves may have a better response to Chiari malformation decompression.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts
| | - Patrick J Cahill
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia
| | - Marie Roguski
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Patrick A Sugrue
- Department of Neurosurgery, Northwestern Medical Center, Chicago, Illinois
| | - Noriaki Kawakami
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
| | - Peter F Sturm
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Randal R Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey; and
| | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Center, Halifax, Nova Scotia, Canada
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, Pennsylvania
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Kennedy BC, Nelp TB, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Feldstein NA, Anderson RCE. Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr 2015; 16:599-606. [PMID: 26314201 DOI: 10.3171/2015.4.peds1572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECT Chiari malformation Type I (CM-I) is associated with a syrinx in 25%-85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-I, many surgeons prefer to open the dura if a syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-I. METHODS A retrospective review of 68 consecutive pediatric patients with CM-I and syringomyelia who underwent PFD without dural opening was conducted. Patient demographics, presenting symptoms and signs, radiographic findings, and intraoperative ultrasound and neuromonitoring findings were studied as well as the patients' clinical and radiographic follow-up. RESULTS During the mean radiographic follow-up period of 32 months, 70% of the syringes improved. Syrinx improvement occurred at a mean of 31 months postoperatively. All patients experienced symptom improvement within the 1st year, despite only 26% of patients showing radiographic improvement during that period. Patients presenting with sensory symptoms or motor weakness had a higher likelihood of having radiographic syrinx improvement postoperatively. CONCLUSIONS In children with CM-I and a syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but this does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.
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Affiliation(s)
| | | | | | | | | | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Neil A Feldstein
- Department of Neurological Surgery and.,Children's Hospital of New York, Columbia University, New York, New York; and
| | - Richard C E Anderson
- Department of Neurological Surgery and.,Children's Hospital of New York, Columbia University, New York, New York; and
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Abstract
OBJECT Syringohydromyelia is frequently identified on spinal imaging. The literature provides little guidance to decision making regarding the need for follow-up or treatment. The purpose of this study was to review the authors' experience in managing pediatric syringohydromyelia of unknown cause. METHODS A single-institution retrospective review of all cases involving pediatric patients who underwent spinal MRI from 2002 to 2012 was conducted. Patients with idiopathic syringohydromyelia (IS) were identified and categorized into 2 subgroups: uncomplicated idiopathic syrinx and IS associated with scoliosis. Clinical and radiological course were analyzed. RESULTS Ninety-eight patients (50 female, 48 male) met the inclusion criteria. Median age at diagnosis of syrinx was 11.9 years. Median maximum syrinx size was 2 mm (range 0.5-17 mm) and spanned 5 vertebral levels (range 1-20 vertebral levels). Thirty-seven patients had scoliosis. The most common presenting complaint was back pain (26%). Clinical follow-up was available for 78 patients (80%), with a median follow-up of 20.5 months (range 1-143 months). A neurological deficit existed at presentation in 36% of the patients; this was either stable or improved at last follow-up in 64% of cases. Radiological follow-up was available for 38 patients (39%), with a median duration of 13 months (range 2-83 months). There was no change in syrinx size in 76% of patients, while 16% had a decrease and 8% had an increase in syrinx size. Thirty-six patients had both clinical and radiological follow-up. There was concordance between clinical and radiological course in 14 patients (39%), with 11 patients (31%) showing no change and 3 patients (8%) showing clinical and radiological improvement. No patients had concurrent deterioration in clinical and radiological course. One patient with scoliosis and muscular dystrophy underwent direct surgical treatment of the syrinx and subsequently had a deteriorated clinical course and decreased syrinx size. CONCLUSIONS There remains a paucity of data regarding the management of pediatric IS. IS in association with scoliosis can complicate neurosurgical decision making. There was no concordance between radiological syrinx size increase and clinical deterioration in this cohort, indicating that surgical decision making should reflect clinical course as opposed to radiological course.
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Affiliation(s)
- Analiz Rodriguez
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Elizabeth N Kuhn
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Aravind Somasundaram
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Daniel E Couture
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
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12
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Godzik J, Holekamp TF, Limbrick DD, Lenke LG, Park TS, Ray WZ, Bridwell K, Kelly MP. Risks and outcomes of spinal deformity surgery in Chiari malformation, Type 1, with syringomyelia versus adolescent idiopathic scoliosis. Spine J 2015; 15:2002-8. [PMID: 25959792 PMCID: PMC4550545 DOI: 10.1016/j.spinee.2015.04.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/24/2015] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Chiari malformation, Type 1, with syringomyelia (CIM+SM) is often associated with spinal deformity. The safety of scoliosis surgery this population is controversial and has never been directly compared with adolescent idiopathic scoliosis (AIS). PURPOSE The purpose of this study was to compare the safety and subjective outcomes of spinal deformity surgery between patients with Chiari malformation Type 1-associated scoliosis and a matched AIS cohort. STUDY DESIGN This study is based on a retrospective matched cohort analysis. PATIENT SAMPLE Patients with CIM+SM and treated with spinal fusion for spinal deformity were identified in the surgical records of a single institution and were matched, 1:1, with AIS patients undergoing spinal fusion at the same institution. OUTCOME MEASURES The outcome measures were neurological monitoring data quality and integrity, radiographic parameters, and Scoliosis Research Society Questionnaire-22 (SRS-22) scores. METHODS A clinical database was reviewed for patients undergoing spinal reconstruction for CIM+SM-associated spinal deformity at our institution from 2000 to 2012. Thirty-six CIM+SM patients were identified and matched to an AIS cohort (1:1) based on age, gender, major curve magnitude, fusion length, and revision status. Demographics, deformity morphology, surgical details, neuromonitoring data, and preoperative and postoperative SRS-22 scores were recorded at a minimum of 2-year follow-up. Changes in SRS-22 scores were compared within and between groups. Complications and neurological monitoring data issues were compared between groups. RESULTS Mean age was 14.5±5 years (CIM+SM: 14.6±5; AIS: 14.4±5), and 42% of patients were male. Preoperative mean major coronal Cobb measured 58°±25° versus 57°±17° (p=.84) with mean kyphosis 52°±17° versus 41°±20° (p=.018). An average of 10.4±2.6 vertebral levels were fused (10.4±2.8 vs. 10.4±2.3, p=.928). No differences existed in surgical approach (p=.336), estimated blood loss (680±720 vs. 660±310 mL, p=.845), or duration of surgery (6.0±2.2 vs. 5.6±2 hours, p=.434). Complication rate was comparable between the two groups (33% vs. 14%, p=.052). Chiari malformation, Type 1, with syringomyelia experienced more neurological complications (11% vs. 0%, p=.04) and neuromonitoring difficulties (28% vs. 3%, p=.007) than the AIS cohort. Mean curve correction was comparable at 2 years (58% CIM+SM vs. 64% AIS, p=.2). At follow-up, both CIM+SM and AIS groups demonstrated improved cumulative SRS-22 outcome subscores (CIM+SM: +0.4, p=.027; AIS: +0.3, p<.001). No difference in outcome subscores existed between CIM+SM and AIS groups. CONCLUSIONS Although CIM+SM patients undergoing spine reconstruction can expect similar deformity corrections and outcome scores to AIS patients, they also experience higher rates of neuromonitoring difficulties and neurological complications related to surgery. Surgeons should be prepared for these difficulties, particularly in children with larger syrinx size.
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Affiliation(s)
- Jakub Godzik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Terrence F. Holekamp
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO,St. Louis Children’s Hospital, St. Louis, MO
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - TS Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO,St. Louis Children’s Hospital, St. Louis, MO
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Keith Bridwell
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO,Corresponding Author and Address: Michael P. Kelly, MD, Assistant Professor, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, Missouri 63110, , Tel: (314) 747-2535; Fax: (314) 747-2599
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13
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Kelly MP, Guillaume TJ, Lenke LG. Spinal Deformity Associated with Chiari Malformation. Neurosurg Clin N Am 2015; 26:579-85. [PMID: 26408068 DOI: 10.1016/j.nec.2015.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the frequency of Chiari-associated spinal deformities, this disease process remains poorly understood. Syringomyelia is often present; however, this is not necessary and scoliosis has been described in the absence of a syrinx. Decompression of the hindbrain is often recommended. In young patients (<10 years old) and/or those with small coronal Cobb measurements (<40°), decompression of the hindbrain may lead to resolution of the spinal deformity. Spinal fusion is reserved for those curves that progress to deformities greater than 50°. Further research is needed to understand the underlying pathophysiology to improve prognostication and treatment of this patient population.
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Affiliation(s)
- Michael P Kelly
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8233, Saint Louis, MO 63110, USA.
| | - Tenner J Guillaume
- Department of Orthopedic Surgery, Gillette Children's Hospital, 200 University Ave E, St Paul, MN 55101, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8233, Saint Louis, MO 63110, USA
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14
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Godzik J, Kelly MP, Radmanesh A, Kim D, Holekamp TF, Smyth MD, Lenke LG, Shimony JS, Park TS, Leonard J, Limbrick DD. Relationship of syrinx size and tonsillar descent to spinal deformity in Chiari malformation Type I with associated syringomyelia. J Neurosurg Pediatr 2014; 13:368-74. [PMID: 24527859 PMCID: PMC4141637 DOI: 10.3171/2014.1.peds13105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Chiari malformation Type I (CM-I) is a developmental abnormality often associated with a spinal syrinx. Patients with syringomyelia are known to have an increased risk of scoliosis, yet the influence of specific radiographically demonstrated features on the prevalence of scoliosis remains unclear. The primary objective of the present study was to investigate the relationship of maximum syrinx diameter and tonsillar descent to the presence of scoliosis in patients with CM-I-associated syringomyelia. A secondary objective was to explore the role of craniovertebral junction (CVJ) characteristics as additional risk factors for scoliosis. METHODS The authors conducted a retrospective review of pediatric patients evaluated for CM-I with syringomyelia at a single institution in the period from 2000 to 2012. Syrinx morphology and CVJ parameters were evaluated with MRI, whereas the presence of scoliosis was determined using standard radiographic criteria. Multiple logistic regression was used to analyze radiological features that were independently associated with scoliosis. RESULTS Ninety-two patients with CM-I and syringomyelia were identified. The mean age was 10.5 ± 5 years. Thirty-five (38%) of 92 patients had spine deformity; 23 (66%) of these 35 patients were referred primarily for deformity, and 12 (34%) were diagnosed with deformity during workup for other symptoms. Multiple regression analysis revealed maximum syrinx diameter > 6 mm (OR 12.1, 95% CI 3.63-40.57, p < 0.001) and moderate (5-12 mm) rather than severe (> 12 mm) tonsillar herniation (OR 7.64, 95% CI 2.3-25.31, p = 0.001) as significant predictors of spine deformity when controlling for age, sex, and syrinx location. CONCLUSIONS The current study further elucidates the association between CM-I and spinal deformity by defining specific radiographic characteristics associated with the presence of scoliosis. Specifically, patients presenting with larger maximum syrinx diameters (> 6 mm) have an increased risk of scoliosis.
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Affiliation(s)
- Jakub Godzik
- Department of Orthopaedic Surgery, Washington University School of Medicine
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University School of Medicine
| | - Alireza Radmanesh
- Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - David Kim
- Department of Neurological Surgery, Washington University School of Medicine
| | | | - Matthew D. Smyth
- Department of Neurological Surgery, Washington University School of Medicine,Department of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, Washington University School of Medicine
| | - Joshua S. Shimony
- Department of Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - Tae Sung Park
- Department of Neurological Surgery, Washington University School of Medicine,Department of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
| | - Jeffrey Leonard
- Department of Neurological Surgery, Washington University School of Medicine,Department of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine,Department of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri
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15
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Balioğlu MB, Albayrak A, Atıcı Y, Tacal MT, Kaygusuz MA, Yıldırım CH, Kaya M, Taşdemiroğlu E, Akbaşak A. Scoliosis-Associated Cervical Spine Pathologies. Spine Deform 2014; 2:131-142. [PMID: 27927379 DOI: 10.1016/j.jspd.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/16/2013] [Accepted: 11/02/2013] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A total of 126 scoliosis patients admitted to the hospital were screened for concomitant cervical pathologies. OBJECTIVES To investigate the prevalence of cervical spine pathologies and the clinical relevance of magnetic resonance imaging (MRI) in the evaluation of patients with neuromuscular, congenital, syndromic, and idiopathic scoliosis. BACKGROUND SUMMARY With the development of MRI, upper neural axis abnormalities such as syringomyelia and Chiari malformation are increasingly being found in patients with scoliosis, but no report in the literature describes other pathologies in the cervical area seen concomitant with different scoliosis types. METHODS A total of 126 consecutive patients who were classified as having neuromuscular, congenital, syndromic, and idiopathic scoliosis were retrospectively evaluated. Data regarding cervical neural axis abnormalities obtained from the MRI studies were analyzed and classified into each type of scoliosis group. RESULTS A total of 126 patients with scoliosis were evaluated for hindbrain and cervical spine anomalies. Patients were divided into 4 groups regarding the type of scoliosis. The cervical spine of all patients was evaluated with MRI and other radiologic methods when needed. The most frequently seen pathology was syringomyelia. Other pathologies found included congenital vertebral anomalies, Chiari malformation, arachnoid cyst, atlanto-axial dissociation, split cord, posterior vertebral fusion, vertebral hypoplasia, neurenteric cyst, myelomalacia, dermoid cyst, and decrease in craniovertebral angle. Cervical pathologies were most frequently seen in neuromuscular scoliosis, followed by congenital and syndromic groups. CONCLUSIONS Cervical spinal pathologies vary according to the type of scoliosis. The number of cervical spinal pathologies diagnosed in idiopathic scoliosis patients was least compared with neuromuscular and syndromic groups. The most common pathology was syringomyelia, followed by congenital vertebral anomalies and cerebral tonsillar hernia. Preoperative MRI scan provides vital information regarding cervical spinal pathologies encountered in scoliosis patients.
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Affiliation(s)
- Mehmet B Balioğlu
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey.
| | - Akif Albayrak
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Yunus Atıcı
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Mehmet T Tacal
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Mehmet A Kaygusuz
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Can H Yıldırım
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Miktat Kaya
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Erol Taşdemiroğlu
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Aytaç Akbaşak
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
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16
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Glagolev NV. [Scoliotic spine deformity in children and adolescents associated with the craniovertebral junction pathology]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2014; 78:80-84. [PMID: 25874289 DOI: 10.17116/neiro201478680-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This literature review is devoted to the clinical and pathogenic aspects of the relationship between Chiari type I malformation (CMT) and scoliosis. The view of the clinical presentation development in CMT associated with scoliosis is considered on the basis of both the CSF dynamics disturbances and vascular pathology of the craniovertebral junction. The role of the posterior atlanto-occipital membrane is evaluated. Case reports of the risk factors for scoliosis progression in patients with CMT are presented.
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Affiliation(s)
- N V Glagolev
- BUZ VO "Oblastnaia detskaia klinicheskaia bol'nitsa #2", Voronezh
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17
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Oda JE, Shah SA, Mackenzie WG, Akbarnia BA, Yazici M. Concurrent tethered cord release and growing-rod implantation-is it safe? Global Spine J 2012; 2:207-12. [PMID: 24353969 PMCID: PMC3864420 DOI: 10.1055/s-0032-1330941] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/15/2012] [Indexed: 01/24/2023] Open
Abstract
Study Design Retrospective case series from one institution with a comparison control group. Objective To evaluate the safety of concomitant tethered cord release and growing-rod insertion in individuals with early onset scoliosis. Methods We retrospectively reviewed patients who underwent concurrent tethered cord release and growing-rod insertion. We compared our data to a comparison control group of eight patients who underwent staged tethered cord release and growing-rod insertion. Results We identified three patients meeting criteria. There were no neurological complications in the three patients who underwent concomitant surgery. Average immediate postoperative curve correction was 43.3 degrees (47.6%). We identified seven patients who underwent staged surgery from a multicenter prospective database. No neurological complications were reported, and average immediate postoperative correction was 35.1 degrees (46.2%). Conclusion We believe that concurrent tethered cord release and growing-rod insertion can be performed safely with the use of multimodality neurophysiological monitoring techniques.
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Affiliation(s)
- Jon E. Oda
- Department of Orthopaedic Surgery, Children's Hospital Central California, Madera, California,Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Suken A. Shah
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware,Growing Spine Study Group, La Jolla, California,Address for correspondence and reprint requests Suken A. Shah, MD Nemours/Alfred I. duPont Hospital for Children1600 Rockland RoadWilmington, DE 19899
| | - William G. Mackenzie
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Behrooz A. Akbarnia
- Growing Spine Study Group, La Jolla, California,San Diego Center for Spinal Disorders, La Jolla, California
| | - Muharrem Yazici
- Growing Spine Study Group, La Jolla, California,Deptartment of Orthopaedic Surgery, Hacettepe University, Sihhiye, Ankara, Turkey
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19
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Abul-Kasim K, Gomez-Hassan D, McCormick L, Maly P, Sundgren P. MRI Findings in Spinal MRI of 306 Children with Scoliosis. Neuroradiol J 2008; 21:672-7. [DOI: 10.1177/197140090802100511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/07/2008] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the MRI findings and assess the prevalence of different associated structural abnormalities in children with scoliosis and to determine if the age of onset is a possible indicator of intraspinal pathology. This is a retrospective analysis of 663 consecutive MR examinations (319 patients). Thirteen patients with known intraspinal tumors were excluded and a total of 306 patients aged 2–18 years with scoliosis were subjected for analysis. The scoliosis was regarded as idiopathic in 62% of patients. Among the remaining 38% the most commonly seen abnormality was syrinx and Chiari malformations. There was no statistically significant difference in the occurrence of syrinx only or syrinx associated with Chiari I malformation in patients younger than ten years and those older than ten years. MRI examination is an essential part of the work up of scoliosis in the pediatric population especially before any corrective surgery. This study and a review of the current literature suggest there is no clinical marker that would definitely serve as an indicator of the presence of intraspinal pathology in these patients.
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Affiliation(s)
- K. Abul-Kasim
- Malmoe University Hospital, University of Lund; Malmoe, Sweden
| | | | - L. McCormick
- Departments of Radiology University of Michigan Health Systems; Ann Arbor, MI, USA
| | - P. Maly
- Malmoe University Hospital, University of Lund; Malmoe, Sweden
| | - P.C. Sundgren
- Departments of Radiology University of Michigan Health Systems; Ann Arbor, MI, USA
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Attenello FJ, McGirt MJ, Gathinji M, Datoo G, Atiba A, Weingart J, Carson B, Jallo GI. OUTCOME OF CHIARI-ASSOCIATED SYRINGOMYELIA AFTER HINDBRAIN DECOMPRESSION IN CHILDREN. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000316848.55059.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Hankinson TC, Klimo P, Feldstein NA, Anderson RC, Brockmeyer D. Chiari Malformations, Syringohydromyelia and Scoliosis. Neurosurg Clin N Am 2007; 18:549-68. [DOI: 10.1016/j.nec.2007.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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