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Bauer DF, Niazi T, Qaiser R, Infinger LK, Vachhrajani S, Ackerman LL, Jackson EM, Jernigan S, Maher CO, Pattisapu JV, Quinsey C, Raskin JS, Rocque BG, Silberstein H. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Diagnosis. Neurosurgery 2023; 93:723-726. [PMID: 37646512 DOI: 10.1227/neu.0000000000002633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians. OBJECTIVE To perform a systematic review of the medical literature to answer specific questions on the diagnosis and treatment of CIM. METHODS PubMed and Embase were queried between 1946 and January 23, 2021, using the search strategies provided in Appendix I of the full guidelines. RESULTS The literature search yielded 567 abstracts, of which 151 were selected for full-text review, 109 were then rejected for not meeting the inclusion criteria or for being off-topic, and 42 were included in this systematic review. CONCLUSION Three Grade C recommendations were made based on Level III evidence. The full guidelines can be seen online at https://www.cns.org/guidelines/browse-guidelines-detail/1-imaging .
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Affiliation(s)
- David F Bauer
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston , Texas , USA
| | - Toba Niazi
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami , Florida , USA
| | - Rabia Qaiser
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis , Indiana , USA
| | - Libby Kosnik Infinger
- Department of Neurosurgery, Medical University of South Carolina (MUSC), Charleston , South Carolina , USA
| | - Shobhan Vachhrajani
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton , Ohio , USA
| | - Laurie L Ackerman
- Department of Neurological Surgery, Indiana University Health, Indianapolis , Indiana , USA
| | - Eric M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Sarah Jernigan
- Carolina Neurosurgery & Spine Associates, Charlotte , North Carolina , USA
| | - Cormac O Maher
- Department of Neurosurgery, Stanford Medicine, Palo Alto , California , USA
| | - Jogi V Pattisapu
- Pediatric Neurosurgery, University of Central Florida College of Medicine, Orlando , Florida , USA
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina Chapel Hill, Chapel Hill , North Carolina , USA
| | - Jeffrey S Raskin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Howard Silberstein
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester , New York , USA
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Hershkovich O, Lotan R, Steinberg N, Katzouraki G, D'Aquino D, Tsegaye M. Treatment of Chiari Malformation and Concomitant Paediatric Scoliosis Long-Term Follow-Up in One Major Referral Centre in the UK. J Clin Med 2023; 12:jcm12103409. [PMID: 37240514 DOI: 10.3390/jcm12103409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Paediatric scoliosis (PS) and Chiari malformation type 1 (CM-1) have been reported to be associated with each other. Scoliosis curvature is a common finding among patients operated for CM-1, and curve development has been related to it. We report a cohort of PS and CM-1 patients managed with posterior fossa and upper cervical decompression (PFUCD) by a single surgeon, with an average of two years of follow-up. METHODS We present a retrospective cohort in a single referral centre for patients with CM-1 and PS. RESULTS From 2011 to 2018, we identified fifteen patients with CM-1 and PS; eleven underwent PFUCD, ten had symptomatic CM-1, and one had asymptomatic CM-1 but showed curve progression. The remaining four CM-1 patients were asymptomatic and were hence treated conservatively. The average follow-up post-PFUCD was 26.2 months. Scoliosis surgery was performed in seven cases; six patients underwent PFUCD prior to the scoliosis correction. One scoliosis case underwent surgery in the presence of mild CM-1 treated conservatively. The remaining four cases were scheduled for scoliosis correction surgery, while three were managed conservatively, with one case lost to follow-up. The average time between PFUCD and scoliosis surgery was 11 months. None of the cases had intraoperative neuromonitoring alerts or perioperative neurological complications. CONCLUSION CM-1 with concomitant scoliosis can be found. Symptomatic CM-1 might require surgery, but as we discovered, PFUCD had negligible effect on curve progression and the future need for scoliosis surgery.
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Affiliation(s)
- Oded Hershkovich
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK
- Department of Orthopedic Surgery, Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Netanel Steinberg
- Department of Orthopedic Surgery, Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Holon 5822012, Israel
| | - Galateia Katzouraki
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Daniel D'Aquino
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Magnum Tsegaye
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Soleman J, Roth J, Constantini S. Chiari Type 1 Malformation and Syringomyelia in Children: Classification and Treatment Options. Adv Tech Stand Neurosurg 2023; 48:73-107. [PMID: 37770682 DOI: 10.1007/978-3-031-36785-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Chiari type 1 malformation (CIM) is defined as tonsillar ectopia of >5 mm, while syringomyelia (SM) is defined as a cerebrospinal fluid (CSF)-filled cavity larger than 3 mm dissecting the spinal cord. Over the last decades, our understanding of these pathologies has grown; however, many controversies still exist almost in every aspect of CIM and SM, including etiology, indication for treatment, timing of treatment, surgical technique, follow-up regime, and outcome. This chapter provides a comprehensive overview on different aspects of CIM and SM and on the still existing controversies, based on the evidence presently available. Future directions for clinical research concerning CIM and SM treatment and outcome are elaborated and discussed as well.
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Affiliation(s)
- Jehuda Soleman
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
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Mahadewa TGB, Awyono S, Maliawan S, Golden N, Niryana IW. Comparison between Dura-Splitting Technique with Duraplasty in Symptomatic Patients with Chiari Malformation Type I: A Systematic Review and Meta-analysis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: There are many surgical procedures for CIM patients, posterior fossa decompression with fibrous band excision, with additional duraplasty, or syringosubdural shunt for syringomyelia related CIM. Prospective studies have been carried out but yet no conclusion, on which one is the best option. The objective of this study was to assess qualitatively the outcome of posterior fossa decompression with dura-splitting (PFDDS) technique compared to posterior fossa decompression with duraplasty (PFDDP) for treating CIM patients.
AIM: This study aimed to give us a preference while conducting surgery in a patient with Chiari malformation type I (CIM) between posterior fossa decompression with incision of the fibrous band of the dura (dura-splitting/DS) technique and duraplasty (DP) technique.
METHODS: The analysis conducted using PRISMA flowchart with PICO framework (Patient: Chiari malformation type I patient over preschool age; Intervention: Dura-splitting; Comparison: Duraplasty; and Outcome: Complication rate, length of stay, reoperation rate, syrinx reduction, symptomatic improvement, and operation time) and already registered for meta-analysis study with database searching from PubMed, the Cochrane Library, and Google Scholar that following inclusion criteria: (1) Original study; (2) study that compares DS and DP in CM- I; and (3) patient age over preschool age.
RESULTS: A review of five included studies involving 458 patients met the inclusion criteria, in which 319 patients treated with DS surgery and 139 for DP surgery for this study. Significantly DS technique correlated lower rate of complication (RR = 0.20; p < 0.0001), shorter length of stay (MD = −3.53; p = 0.0002), and shorter operation time (MD = −58.59; p = 0.0004). No significant differences in reoperation rate (RR = 1.90; p = 0.22), symptom improvement (RR = 1.12; p = 0.44), and syrinx reduction (RR = 1.11; p = 0.56) were noted.
CONCLUSIONS: Posterior fossa decompression using the DS technique is associated with a lower rate of complication, shorter length of stay, and shorter operation time. However, no significant differences were found in the reoperation rate, symptom improvement, and syringomyelia reduction between these two techniques.
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Rodriguez VV, Tello CA, Piantoni L, Wilson IAF, Galareto E, Remondino RG, Bersusky SE, Davies R, Noel MA. Chiari 1: Is decompression always necessary previous to scoliosis surgery? Spine Deform 2021; 9:1253-1258. [PMID: 33792837 DOI: 10.1007/s43390-021-00336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
The association between Chiari 1 malformation and scoliosis is well known in the literature. Prevalence has increased after the advent of magnetic resonance imaging. In children with this association, prophylactic suboccipital decompression prior to scoliosis correction is a common surgical procedure although the rationale for this surgical management and whether not performing it may lead to spinal cord injury has not been clearly elucidated. We conducted a systematic review of the literature with the aim to obtain strong data to support the hypothesis that it is safe to proceed with scoliosis correction without prior prophylactic suboccipital decompression for Chiari 1 in an asymptomatic population. Using the Prisma methodology, we analyzed 3250 studies published between 1972 and 2018. Only four studies met the inclusion criteria. None of the studies had a level of evidence high enough to recommend prophylactic decompression previous to correction of the spinal deformity.
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Affiliation(s)
- V Vazquez Rodriguez
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - C A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - L Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina.
| | - I A Francheri Wilson
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - E Galareto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R G Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - S E Bersusky
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R Davies
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - M A Noel
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
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6
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O'Neill NP, Miller PE, Hresko MT, Emans JB, Karlin LI, Hedequist DJ, Snyder BD, Smith ER, Proctor MR, Glotzbecker MP. Scoliosis with Chiari I malformation without associated syringomyelia. Spine Deform 2021; 9:1105-1113. [PMID: 33471302 DOI: 10.1007/s43390-021-00286-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Many patients with presumed idiopathic scoliosis are found to have Chiari I malformation (CM-I) on MRI. The objective of this study is to report on scoliosis progression in CM-I with no syringomyelia. METHODS A retrospective review of patients with scoliosis and CM-I was conducted from 1997 to 2015. Patients with syringomyelia and/or non-idiopathic scoliosis were excluded. Clinical and radiographic characteristics were recorded at presentation and latest follow-up. CM-I was defined as the cerebellar tonsil extending 5 mm or more below the foramen magnum on MRI. RESULTS Thirty-two patients (72% female) with a mean age of 11 years (range 1-16) at scoliosis diagnosis were included. The average initial curve was 30.3° ± SD 16.3. The mean initial Chiari size was 9.6 mm SD ± 4.0. Fifteen (46.9%) experienced Chiari-related symptoms, and three (9%) patients underwent Posterior Fossa Decompression (PFD) to treat these symptoms. 10 (31%) patients went on to fusion, progressing on average 13.6° (95% CI 1.6-25.6°). No association was detected between decompression and either curve progression or fusion (p = 0.46, 0.60). For those who did not undergo fusion, curve magnitude progressed on average 1.0° (95% CI - 4.0 to 5.9°). There was no association between age, Chiari size, presence of symptoms, initial curve shape, or bracing treatment and fusion. CONCLUSION Patients with CM-I and scoliosis may not require surgical treatment, including PFD and fusion. Scoliosis curvature stabilized in the non-surgical population at an average progression of 1.0°. These results suggest that CM-I with no syringomyelia has minimal effect on scoliosis progression.
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Affiliation(s)
- Nora P O'Neill
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Michael T Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence I Karlin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Pediatric Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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7
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Luo M, Wu D, You X, Deng Z, Liu L, Song Y, Huang S. Are craniocervical angulations or syrinx risk factors for the initiation and progression of scoliosis in Chiari malformation type I? Neurosurg Rev 2020; 44:2299-2308. [PMID: 33097988 DOI: 10.1007/s10143-020-01423-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
The pathophysiology behind the instigation and progression of scoliosis in Chiari malformation type I (CMI) patients has not been elucidated yet. This study aims to explore the initiating and progressive factors for scoliosis secondary to CMI. Pediatric patients with CMI were retrospectively reviewed for radiological characteristics of tonsillar herniation, craniocervical anomaly, syrinx morphology, and scoliosis. Subgroup analyses of the presence of syrinx, scoliosis, and curve progression were also performed. A total of 437 CMI patients were included in the study; 62% of the subjects had syrinx, and 25% had scoliosis. In the subgroup analysis of 272 CMI patients with syrinx, 78 of them (29%) had scoliosis, and multiple logistic regression analysis showed that tonsillar herniation ≥ 10 mm (OR 2.13; P = 0.033) and a clivus canal angle ≤ 130° (OR 1.98; P = 0.025) were independent risk factors for scoliosis. In the subgroup analysis of 165 CMI patients without syrinx, 31 of them (19%) had scoliosis, and multiple logistic regression analysis showed that a clivus canal angle ≤ 130° (OR 3.02; P = 0.029) was an independent risk factor for scoliosis. In the subgroup analysis of curve progression for 97 CMI patients with scoliosis, multiple logistic regression analysis showed that anomalies of the craniocervical junction and syrinx were not risk factors for curve progression. Many complex factors including craniocervical angulation, tonsillar herniation, and syrinx might participate in the instigation of scoliosis for CMI patients, and the relationship between craniocervical angulation and scoliosis deserves further study.
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Affiliation(s)
- Ming Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Diwei Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Xuanhe You
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhipeng Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China.
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China.
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Strahle JM, Taiwo R, Averill C, Torner J, Gewirtz JI, Shannon CN, Bonfield CM, Tuite GF, Bethel-Anderson T, Anderson RCE, Kelly MP, Shimony JS, Dacey RG, Smyth MD, Park TS, Limbrick DD. Radiological and clinical associations with scoliosis outcomes after posterior fossa decompression in patients with Chiari malformation and syrinx from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 2020; 26:53-59. [PMID: 32276246 DOI: 10.3171/2020.1.peds18755] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In patients with Chiari malformation type I (CM-I) and a syrinx who also have scoliosis, clinical and radiological predictors of curve regression after posterior fossa decompression are not well known. Prior reports indicate that age younger than 10 years and a curve magnitude < 35° are favorable predictors of curve regression following surgery. The aim of this study was to determine baseline radiological factors, including craniocervical junction alignment, that might predict curve stability or improvement after posterior fossa decompression. METHODS A large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and a syrinx (≥ 3 mm in width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°) in patients who underwent posterior fossa decompression and who also had follow-up imaging. RESULTS Of 825 patients with CM-I and a syrinx, 251 (30.4%) were noted to have scoliosis present at the time of diagnosis. Forty-one (16.3%) of these patients underwent posterior fossa decompression and had follow-up imaging to assess for scoliosis. Twenty-three patients (56%) were female, the mean age at time of CM-I decompression was 10.0 years, and the mean follow-up duration was 1.3 years. Nine patients (22%) had stable curves, 16 (39%) showed improvement (> 5°), and 16 (39%) displayed curve progression (> 5°) during the follow-up period. Younger age at the time of decompression was associated with improvement in curve magnitude; for those with curves of ≤ 35°, 17% of patients younger than 10 years of age had curve progression compared with 64% of those 10 years of age or older (p = 0.008). There was no difference by age for those with curves > 35°. Tonsil position, baseline syrinx dimensions, and change in syrinx size were not associated with the change in curve magnitude. There was no difference in progression after surgery in patients who were also treated with a brace compared to those who were not treated with a brace for scoliosis. CONCLUSIONS In this cohort of patients with CM-I, a syrinx, and scoliosis, younger age at the time of decompression was associated with improvement in curve magnitude following surgery, especially in patients younger than 10 years of age with curves of ≤ 35°. Baseline tonsil position, syrinx dimensions, frontooccipital horn ratio, and craniocervical junction morphology were not associated with changes in curve magnitude after surgery.
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Affiliation(s)
- Jennifer M Strahle
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rukayat Taiwo
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christine Averill
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - James Torner
- 2Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Jordan I Gewirtz
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chevis N Shannon
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald F Tuite
- 4Department of Neurosurgery, Neuroscience Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Tammy Bethel-Anderson
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Richard C E Anderson
- 6Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Michael P Kelly
- 7Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S Shimony
- 5Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ralph G Dacey
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Smyth
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tae Sung Park
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David D Limbrick
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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9
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Verhofste BP, Davis EA, Miller PE, Hresko MT, Emans JB, Karlin LI, Hedequist DJ, Snyder BD, Smith ER, Proctor MR, Glotzbecker MP. Chiari I malformations with syringomyelia: long-term results of neurosurgical decompression. Spine Deform 2020; 8:233-243. [PMID: 31933098 DOI: 10.1007/s43390-019-00009-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES The objective was to assess the long-term outcomes on scoliosis following Chiari-I (CM-I) decompression in patients with CM-I and syringomyelia (SM). A secondary objective was to identify risk factors of scoliosis progression. BACKGROUND The association between CM-I with SM and scoliosis is recognized, but it remains unclear if CM-I decompression alters the long-term evolution of scoliosis in patients with associated syringomyelia. METHODS A retrospective review of children with scoliosis, CM-I, and SM during 1997-2015 was performed. Congenital, syndromic, and neuromuscular scoliosis were excluded. Clinical and radiographic characteristics were recorded at presentation, pre-decompression, after 1-year, and latest follow-up. A scale to measure syringomyelia area on MRI was used to evaluate SM changes post-decompression. RESULTS 65 children with CM-I, SM, and scoliosis and a mean age of 8.9 years (range 0.7-15.8) were identified. Mean follow-up was 6.9 years (range 2.0-20.4). Atypical curves were present in 28 (43%) children. Thirty-eight patients (58%) underwent decompression before 10 years. Syringomyelia size reduced a mean of 70% after decompression (p < 0.001). Scoliosis improved in 26 (40%), stabilized in 17 (26%), and progressed in 22 (34%) cases. Early spinal fusion was required in 7 (11%) patients after a mean of 0.5 ± 0.37 years and delayed fusion in 16 (25%) patients after 6.0 ± 3.24 years. The remaining 42 (65%) patients were followed for a median of 6.1 years (range 2.0-12.3) without spine instrumentation or fusion. Fusion patients experienced less improvement in curve magnitude 1-year post-decompression (p < 0.001) and had larger curves at presentation (43° vs. 34°; p = 0.004). CONCLUSIONS Syringomyelia size decreased by 70% after CM-I decompression and scoliosis stabilized or improved in two-thirds of patients. Greater curve improvement within the first year post-decompression and smaller curves at presentation decreased the risk of spinal fusion. Neurosurgical decompression is recommended in children with CM-I, SM, and scoliosis with the potential to treat all three conditions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Bram P Verhofste
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Eric A Davis
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Michael T Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Lawrence I Karlin
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, MA, USA
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA. .,Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Strahle JM, Taiwo R, Averill C, Torner J, Shannon CN, Bonfield CM, Tuite GF, Bethel-Anderson T, Rutlin J, Brockmeyer DL, Wellons JC, Leonard JR, Mangano FT, Johnston JM, Shah MN, Iskandar BJ, Tyler-Kabara EC, Daniels DJ, Jackson EM, Grant GA, Couture DE, Adelson PD, Alden TD, Aldana PR, Anderson RCE, Selden NR, Baird LC, Bierbrauer K, Chern JJ, Whitehead WE, Ellenbogen RG, Fuchs HE, Guillaume DJ, Hankinson TC, Iantosca MR, Oakes WJ, Keating RF, Khan NR, Muhlbauer MS, McComb JG, Menezes AH, Ragheb J, Smith JL, Maher CO, Greene S, Kelly M, O'Neill BR, Krieger MD, Tamber M, Durham SR, Olavarria G, Stone SSD, Kaufman BA, Heuer GG, Bauer DF, Albert G, Greenfield JP, Wait SD, Van Poppel MD, Eskandari R, Mapstone T, Shimony JS, Dacey RG, Smyth MD, Park TS, Limbrick DD. Radiological and clinical predictors of scoliosis in patients with Chiari malformation type I and spinal cord syrinx from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 2019; 24:520-527. [PMID: 31419800 DOI: 10.3171/2019.5.peds18527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Scoliosis is frequently a presenting sign of Chiari malformation type I (CM-I) with syrinx. The authors' goal was to define scoliosis in this population and describe how radiological characteristics of CM-I and syrinx relate to the presence and severity of scoliosis. METHODS A large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°). RESULTS Based on available imaging of patients with CM-I and syrinx, 260 of 825 patients (31%) had a clear diagnosis of scoliosis based on radiographs or coronal MRI. Forty-nine patients (5.9%) did not have scoliosis, and in 516 (63%) patients, a clear determination of the presence or absence of scoliosis could not be made. Comparison of patients with and those without a definite scoliosis diagnosis indicated that scoliosis was associated with wider syrinxes (8.7 vs 6.3 mm, OR 1.25, p < 0.001), longer syrinxes (10.3 vs 6.2 levels, OR 1.18, p < 0.001), syrinxes with their rostral extent located in the cervical spine (94% vs 80%, OR 3.91, p = 0.001), and holocord syrinxes (50% vs 16%, OR 5.61, p < 0.001). Multivariable regression analysis revealed syrinx length and the presence of holocord syrinx to be independent predictors of scoliosis in this patient cohort. Scoliosis was not associated with sex, age at CM-I diagnosis, tonsil position, pB-C2 distance (measured perpendicular distance from the ventral dura to a line drawn from the basion to the posterior-inferior aspect of C2), clivoaxial angle, or frontal-occipital horn ratio. Average curve magnitude was 29.9°, and 37.7% of patients had a left thoracic curve. Older age at CM-I or syrinx diagnosis (p < 0.0001) was associated with greater curve magnitude whereas there was no association between syrinx dimensions and curve magnitude. CONCLUSIONS Syrinx characteristics, but not tonsil position, were related to the presence of scoliosis in patients with CM-I, and there was an independent association of syrinx length and holocord syrinx with scoliosis. Further study is needed to evaluate the nature of the relationship between syrinx and scoliosis in patients with CM-I.
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Affiliation(s)
- Jennifer M Strahle
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rukayat Taiwo
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christine Averill
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - James Torner
- 2Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Chevis N Shannon
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald F Tuite
- 4Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, Florida
| | - Tammy Bethel-Anderson
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jerrel Rutlin
- 5Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Douglas L Brockmeyer
- 6Department of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - John C Wellons
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey R Leonard
- 7Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Francesco T Mangano
- 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James M Johnston
- 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama
| | - Manish N Shah
- 10Department of Pediatric Surgery and Neurosurgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Bermans J Iskandar
- 11Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elizabeth C Tyler-Kabara
- 12Department of Neurosurgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - David J Daniels
- 13Department of Neurosurgery, The Mayo Clinic, Rochester, Minnesota
| | - Eric M Jackson
- 14Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gerald A Grant
- 15Department of Neurosurgery, Stanford Child Health Research Institute, Stanford, California
| | - Daniel E Couture
- 16Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - P David Adelson
- 17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Tord D Alden
- 18Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Philipp R Aldana
- 19Department of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Richard C E Anderson
- 20Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nathan R Selden
- 21Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Lissa C Baird
- 21Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Karin Bierbrauer
- 8Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua J Chern
- 22Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia
| | | | - Richard G Ellenbogen
- 24Department of Neurosurgery, University of Washington Medicine, Seattle, Washington
| | - Herbert E Fuchs
- 25Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Daniel J Guillaume
- 26Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Todd C Hankinson
- 27Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | - Mark R Iantosca
- 28Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - W Jerry Oakes
- 9Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama
| | - Robert F Keating
- 29Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Nickalus R Khan
- 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael S Muhlbauer
- 30Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - J Gordon McComb
- 31Division of Neurosurgery, Children's Hospital Los Angeles, California
| | - Arnold H Menezes
- 32Department of Neurosurgery, University of Iowa Hospitals, Iowa City, Iowa
| | - John Ragheb
- 33Department of Pediatric Neurosurgery, Miami Children's Hospital and University of Miami Miller School of Medicine, Miami, Florida
| | - Jodi L Smith
- 34Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cormac O Maher
- 35Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Stephanie Greene
- 12Department of Neurosurgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Michael Kelly
- 36Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brent R O'Neill
- 27Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | - Mark D Krieger
- 31Division of Neurosurgery, Children's Hospital Los Angeles, California
| | - Mandeep Tamber
- 37Department of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan R Durham
- 38Department of Neurosurgery, University of Vermont College of Medicine, Burlington, Vermont
| | | | - Scellig S D Stone
- 40Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Bruce A Kaufman
- 41Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gregory G Heuer
- 42Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - David F Bauer
- 43Department of Neurosurgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Gregory Albert
- 44Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jeffrey P Greenfield
- 45Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Scott D Wait
- 46Department of Neurological Surgery, Levine Children's Hospital, Charlotte, North Carolina
| | - Mark D Van Poppel
- 46Department of Neurological Surgery, Levine Children's Hospital, Charlotte, North Carolina
| | - Ramin Eskandari
- 47Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and
| | - Timothy Mapstone
- 48Department of Neurosurgery, Oklahoma University Medical Center, Oklahoma City, Oklahoma
| | - Joshua S Shimony
- 5Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ralph G Dacey
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Smyth
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tae Sung Park
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David D Limbrick
- 1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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11
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Noureldine MHA, Shimony N, Jallo GI, Groves ML. Scoliosis in patients with Chiari malformation type I. Childs Nerv Syst 2019; 35:1853-1862. [PMID: 31342150 DOI: 10.1007/s00381-019-04309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
The literature about the association between Chiari malformations (CMs) and scoliosis has been growing over the last three decades; yet, no consensus on the optimal management approach in this patient population has been reached. Spinal anomalies such as isolated syrinxes, isolated CM, and CM with a syrinx are relatively common among patients with presumed idiopathic scoliosis (IS), a rule that also applies to scoliosis among CM patients as well. In CM patients, scoliosis presents with atypical features such as early onset, left apical or kyphotic curvature, and neurological deficits. While spinal X-rays are essential to confirm the diagnosis of scoliosis among CM patients, a magnetic resonance imaging (MRI) is also recommended in IS patients with atypical presentations. Hypotheses attempting to explain the occurrence of scoliosis in CM patients include cerebellar tonsillar compression of the cervicomedullary junction and uneven expansion of a syrinx in the horizontal plane of the spinal cord. Early detection of scoliosis on routine spinal examination and close follow-up on curve stability and progression are essential initial steps in the management of scoliosis, especially in patients with CM, who may require full spine MRI to screen for associated neuro-axial anomalies; bracing and spinal fusion may be subsequently pursued in high-risk patients.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA
| | - Nir Shimony
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA
- Geisinger Medical Center, Neuroscience Institute, Danville, PA, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - George I Jallo
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, 600 5th Street South, 4th floor, Saint Petersburg, FL, 33701, USA.
- Johns Hopkins University Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Mari L Groves
- Johns Hopkins University Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
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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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13
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Dulfer SE, Drost G, Lange F, Journee HL, Wapstra FH, Hoving EW. Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery. Childs Nerv Syst 2017; 33:1985-1995. [PMID: 28676974 PMCID: PMC5644688 DOI: 10.1007/s00381-017-3478-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE Patients with tethered spinal cord have been investigated for short-term effects after tethered spinal cord surgery in the past. However, little is known about the long-term effects in this patient group. In this retrospective, longitudinal, observational study, a patient sample of a previous report of 65 patients was reassessed to observe the long-term effects of intraoperative neurophysiological monitoring-assisted tethered cord surgery. METHODS With the use of patient charts and a survey, patients were scored on four domains: (1) neurological deficits, (2) urological deficits, (3) pain symptoms, and (4) orthopedic deficits. Measurements were performed at four moments in time: (1) preoperatively, (2) postoperatively, (3) follow-up 1 (4.6 years), and (4) follow-up 2 (11.2 years). Besides this, a subgroup analysis and a quality of life questionnaire were performed. RESULTS When observing the symptom domains in the long-term, the pain domain appeared to improve most postoperatively after which it remained stable over time. The neurological and urological domains showed a stable, slightly decreasing trend in the long-term follow-up. The orthopedic domain showed a significant increase of the number of patients with scoliosis during the long-term follow-up. CONCLUSIONS Lasting effects of stability in the neurological, urological, and pain domains were observed. Close monitoring during follow-up might contribute to early recognition of progressive scoliosis, in spite of detethering, in a risk group defined by females who underwent tethered cord surgery at or under the age of 12 years old with either lipomyelomeningocele, split cord malformation, or myelomeningocele. Detethering does not appear to protect these patients against progressive scoliosis.
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Affiliation(s)
- S. E. Dulfer
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
| | - G. Drost
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands ,Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
| | - F. Lange
- Department of Neurology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
| | - H. L. Journee
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
| | - F. H. Wapstra
- Department of Orthopedics, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
| | - E. W. Hoving
- Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands
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14
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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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Abstract
STUDY DESIGN A retrospective radiographic analysis. OBJECTIVE The aim of this study was to investigate the scoliosis curve patterns/features and magnetic resonance imaging (MRI) tonsillar ectopia characteristics in Chiari I malformation without syringomyelia (CMI-only). SUMMARY OF BACKGROUND DATA The development of scoliosis associated with a CMI typically has been ascribed to the presence of syringomyelia. However, a subset of CMI patients with scoliosis may not have a concomitant syrinx. Scoliosis in these patients has been very poorly documented in the literature. METHODS A retrospective study was conducted on patients with a scoliosis secondary to CMI-only. The curve direction, curve pattern/features, and side of the dominant tonsillar ectopia were recorded and assessed quantitatively. On the basis of the measurement results, associations between the scoliosis curve patterns/features and MRI tonsillar ectopia characteristics were analyzed. RESULTS A total of 26 patients, consisting of seven males and 19 females with an average age of 15.4 years, were included in the current study. In 19 patients with asymmetrically displaced tonsils, the concordance between the dominant side of the asymmetrically displaced tonsils and curve direction was 78.9%. A statistically significant association was found between the dominant side of the tonsillar ectopia and the convex side of scoliosis according to Fisher exact test (P = 0.045). In addition, it was noted that there was a high incidence (52.9%) of atypical curve patterns in CMI-only patients. A significantly high incidence of atypical features with a superior shift of either the apical or the end vertebrae was found in 85.7% of thoracic curves and 40% of lumbar curves. CONCLUSION Scoliosis associated with CMI-only was found to have atypical curve patterns in all cases, and the direction of scoliosis was highly consistent with the dominant side of asymmetrically tonsillar herniation. These findings should be considered as an argument in favor of a nonidiopathic etiology and lead to more evidence that simple tonsillar impaction can provide enough impetus to produce or exaggerate scoliotic curvature. LEVEL OF EVIDENCE 3.
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16
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Alkoç OA, Songur A, Eser O, Toktas M, Gönül Y, Esi E, Haktanir A. Stereological and Morphometric Analysis of MRI Chiari Malformation Type-1. J Korean Neurosurg Soc 2015; 58:454-61. [PMID: 26713146 PMCID: PMC4688315 DOI: 10.3340/jkns.2015.58.5.454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
Objective In this study, we aimed to investigate the underlying ethiological factors in chiari malformation (CM) type-I (CMI) via performing volumetric and morphometric length-angle measurements. Methods A total of 66 individuals [33 patients (20-65 years) with CMI and 33 control subjects] were included in this study. In sagittal MR images, tonsillar herniation length and concurrent anomalies were evaluated. Supratentorial, infratentorial, and total intracranial volumes were measured using Cavalieri method. Various cranial distances and angles were used to evaluate the platybasia and posterior cranial fossa (PCF) development. Results Tonsillar herniation length was measured 9.09±3.39 mm below foramen magnum in CM group. Tonsillar herniation/concurrent syringomyelia, concavity/defect of clivus, herniation of bulbus and fourth ventricle, basilar invagination and craniovertebral junction abnormality rates were 30.3, 27, 18, 2, 3, and 3 percent, respectively. Absence of cisterna magna was encountered in 87.9% of the patients. Total, IT and ST volumes and distance between Chamberlain line and tip of dens axis, Klaus index, clivus length, distance between internal occipital protuberance and opisthion were significantly decreased in patient group. Also in patient group, it was found that Welcher basal angle/Boogard angle increased and tentorial slope angle decreased. Conclusion Mean cranial volume and length-angle measurement values significantly decreased and there was a congenital abnormality association in nearly 81.5 percent of the CM cases. As a result, it was concluded that CM ethiology can be attributed to multifactorial causes. Moreover, congenital defects can also give rise to this condition.
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Affiliation(s)
- Ozan Alper Alkoç
- Department of Anatomy, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ahmet Songur
- Department of Anatomy, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Olcay Eser
- Department of Neurological Surgery, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Muhsin Toktas
- Department of Anatomy, Faculty of Medicine, Turgut Özal University, Ankara, Turkey
| | - Yücel Gönül
- Department of Anatomy, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Ertap Esi
- Department of Radiology, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Alpay Haktanir
- Department of Radiology, Faculty of Medicine, Ordu University, Ordu, Turkey
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17
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Pindrik J, Johnston JM. Clinical Presentation of Chiari I Malformation and Syringomyelia in Children. Neurosurg Clin N Am 2015; 26:509-14. [PMID: 26408059 DOI: 10.1016/j.nec.2015.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chiari I malformation and syringomyelia may be associated with a wide spectrum of symptoms and signs in children. Clinical presentations vary based on patient age and relative frequency; some diagnoses represent incidental radiographic findings. Occipitocervical pain, propagated or intensified by Valsalva maneuvers (or generalized irritability in younger patients unable to communicate verbally), and syringomyelia with or without scoliosis are the most common clinical presentations. Cranial nerve or brainstem dysfunction also may be observed in younger patients, and is associated with more complex deformity that includes ventral compression secondary to basilar invagination, retroflexion of the dens, and/or craniocervical instability.
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Affiliation(s)
- Jonathan Pindrik
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama, Birmingham (UAB), 1600 7th Avenue South, Lowder 400, Birmingham, AL 35233, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama, Birmingham (UAB), 1600 7th Avenue South, Lowder 400, Birmingham, AL 35233, USA.
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Lee S, Wang KC, Cheon JE, Phi JH, Lee JY, Cho BK, Kim SK. Surgical outcome of Chiari I malformation in children: clinico-radiological factors and technical aspects. Childs Nerv Syst 2014; 30:613-23. [PMID: 24604349 DOI: 10.1007/s00381-013-2263-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The optimal treatment for Chiari I malformation in children is still under debate. The aim of this study was to evaluate the surgical outcome of the pediatric Chiari I malformation,focusing on clinico-radiological factors and technical aspects. METHODS Fifty-six patients with Chiari I malformation who received surgery at Seoul National University Children’s Hospital were included. The mean age was 7.9 years. The patients were divided into three groups: group I (n =8) with hydrocephalus, group II (n =11) without syrinx, and group III (n =37) with syrinx. Group I received shunting operation initially,and others received foramen magnum decompression (FMD). Group III was further subdivided: group IIIa (n =9), minimal intradural manipulation, and group IIIb (n =27), active intradural manipulation. The outcomes were compared between the groups. The mean follow-up period was 75.9 months. RESULTS In group I, symptoms were resolved or had improved in most patients, with only one patient received additional FMD. Symptoms resolved or improved in 10 (91 %) and 25 cases (84 %) in groups II and III, respectively. Syrinx was markedly decreased in 31 cases (86 %) in group III. FMD was less effective for scoliosis (improved or stabilized in 57 %).The persistence of syrinx was related with an aggravation of scoliosis. The outcomes between group IIIa and IIIb showed no significant difference. CONCLUSIONS In most pediatric Chiari I patients with hydrocephalus,a shunting operation was sufficient. FMD showed high efficacy in treating patients without hydrocephalus. The extent of the intradural procedure did not have a significant effect on the clinical outcome.
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Sha S, Zhu Z, Lam TP, Sun X, Qian B, Jiang J, Cheng JCY, Qiu Y. Brace treatment versus observation alone for scoliosis associated with Chiari I malformation following posterior fossa decompression: a cohort study of 54 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1224-31. [PMID: 24619608 DOI: 10.1007/s00586-014-3265-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To be deemed effective in preventing curve progression, brace treatment should show alteration of the expected natural history. Most of the reported studies on the effect of bracing on the evolution of Chiari malformation-associated scoliosis (CMS) following posterior fossa decompression (PFD) were small series with inconclusive results. The goal of this study was to investigate whether post-PFD brace treatment for CMS produces better outcomes than observation alone. METHODS The clinical and radiographic data of 21 patients treated with observation alone (Ob group) and 33 patients receiving brace treatment (Br group) were retrospectively reviewed. Evolution of scoliosis was defined as progression of Cobb angle of the primary curve of >5°, as compared with that at brace initiation. RESULTS At the latest follow-up, curve progression occurred in 10 (30 %) of Br group and 13 (62 %) of Ob group (P = .022). Overall, 8 (24 %) patients in the Br group and 9 (43 %) in the Ob group underwent further scoliosis surgery (P = .151). When analyses were restricted to the 27 braced and 17 observed patients who had reached skeletal maturity or undergone spinal fusion surgery, decreased curve progression and surgical rates were also observed in the Br group though not reaching statistical significance. Results of the survival analysis, however, demonstrated a significantly increased survival proportion in the Br group (0.63 versus 0.35, P = .014). CONCLUSIONS Compared with observation alone, bracing treatment following PFD in patients with CMS was observed to reduce the rates of curve progression and scoliosis surgery. However, patients and their parents should be informed that almost a third of patients still go on to surgery.
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Affiliation(s)
- Shifu Sha
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, 210008, China
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Effectiveness of brace treatment of Chiari malformation-associated scoliosis after posterior fossa decompression: a comparison with idiopathic scoliosis. Spine (Phila Pa 1976) 2013; 38:E299-305. [PMID: 23238491 DOI: 10.1097/brs.0b013e318281dba6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To evaluate the effectiveness of bracing in patients with Chiari malformation-associated scoliosis (CMS) after posterior fossa decompression (PFD). SUMMARY OF BACKGROUND DATA The effectiveness of bracing has been poorly studied in patients with CMS who have undergone PFD. METHODS A retrospective study was conducted on 22 patients with CMS who received brace treatment of scoliosis after PFD. Forty-four age- and sex-matched patients with idiopathic scoliosis (IS) who were treated with bracing served as the control group. The bracing outcome was considered a failure if the curve worsened 6° or more; otherwise, the treatment was considered to be successful. RESULTS The age and Risser sign were similar between patients with CMS and IS at brace initiation. The initial curve magnitude of patients with CMS (mean, 32.9° ± 6.3°; range, 20°-45°) was marginally significantly larger than that of patients with IS (mean, 29.6° ± 6.4°; range, 20°-45°). Until the final follow-up, a 6° or more worsening of the major curve occurred in 8 patients with CMS (36%) and in 15 patients with IS (34%). Overall, 7 patients with CMS (32%) and 13 patients with IS (30%) underwent spinal fusion surgery. No significant differences were observed between the 2 groups in the surgery rates or the bracing success rates (P > 0.05). In patients with CMS, neither the performance of syringosubarachnoid shunting nor the extent of tonsillar descent correlated with the bracing outcomes, whereas a double major curve pattern was found to be predictive for the failure of bracing. CONCLUSION Brace treatment subsequent to PFD is effective in preventing curve progression for 64% of patients with CMS, which is comparable with the rate that is observed in patients with IS. Double major curve pattern may be a risk factor in predicting treatment failure in patients with CMS. LEVEL OF EVIDENCE 3.
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Carew CL, Prasad A, Tay KY, de Ribaupierre S. Unusual presentation of Chiari I in toddlers: case reports and review of the literature. Childs Nerv Syst 2012; 28:1965-70. [PMID: 22661147 DOI: 10.1007/s00381-012-1826-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/23/2012] [Indexed: 11/25/2022]
Abstract
Toddlers with Chiari malformations can present with common symptoms, such as cough or drooling, which are associated with respiratory illnesses, delaying a correct diagnosis. Presentation does vary with age, and therefore can be different in older children when compared to infants. We present two cases of unusual presentations in toddlers and review the literature with an emphasis on acute presentation of Chiari in different age groups in children.
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Affiliation(s)
- Caitlin L Carew
- Schulich School of Medicine and Dentistry, University of Western Ontario, Victoria Hospital, B1-181, 800 Commissionners Rd E, London, ON N6A 5W9, Canada
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Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE. Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci 2012; 19:1268-72. [DOI: 10.1016/j.jocn.2012.01.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/19/2012] [Accepted: 01/21/2012] [Indexed: 01/20/2023]
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Hwang SW, Samdani AF, Jea A, Raval A, Gaughan JP, Betz RR, Cahill PJ. Outcomes of Chiari I-associated scoliosis after intervention: a meta-analysis of the pediatric literature. Childs Nerv Syst 2012; 28:1213-9. [PMID: 22526438 DOI: 10.1007/s00381-012-1739-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Various series have reported successful management of scoliosis after surgical treatment of the associated Chiari malformation, syrinx, or bracing. Multiple factors have been associated with curve progression, but interpretation of outcomes is confounded by the wide range of reported results and size of individual series. We attempted to evaluate the outcomes of Chiari I-associated scoliosis by performing a meta-analysis of currently published data. METHODS We conducted a systematic review of published articles using Medline, PubMed (from 1950 to January 2010), and reference lists of identified articles for Chiari malformation and scoliosis. RESULTS One hundred and twenty patients were identified in 12 studies, of them, 37 % were male. The mean age at the time of surgery was 9.7 ± 4.1 years. The mean curve magnitude at presentation was 34.4 ± 13.0° and progressed to a mean value of 38.9 ± 20.2°, with an average follow-up of 48.3 ± 48.2 months. After surgical intervention, curve magnitude improved in 37 % of patients (n = 42); there was no change in 18 % (n = 20), and curves progressed in 45 % (n = 51). Age (p = 0.0097) and presence of surgical intervention (foramen magnum decompression [p = 0.0099] and syrinx shunting/drainage [p = 0.0039]) were statistically associated with improvement of the scoliotic curve. Surgical decompression of the foramen magnum had the greatest impact on the scoliotic curves. CONCLUSIONS Data accrued from our analysis suggest that curve magnitude will improve after surgical treatment of the Chiari malformation in one third of patients, and curve progression will stabilize or improve in one half.
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Affiliation(s)
- Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA,
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Ayer RE, Zouros A. Encephalocraniocutaneous lipomatosis: a review of its clinical pathology and neurosurgical indications. J Neurosurg Pediatr 2011; 8:316-20. [PMID: 21882925 DOI: 10.3171/2011.6.peds11138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous syndrome whose hallmark lesions are benign lipomas of the brain and spinal cord. The authors present a case of a male infant with ECCL who had extensive brainstem and spinal cord lipomas. The management of this patient's hydrocephalus, cervicomedullary compression, tethered cord, and scoliosis over the course of his first 2 years of life is described. This case report and review of the literature is presented to provide a synopsis of the problems likely to be encountered by neurosurgeons who treat patients with this syndrome.
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Affiliation(s)
- Robert E Ayer
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
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Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJL, Maher CO. Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr 2011; 8:205-13. [PMID: 21806364 DOI: 10.3171/2011.5.peds1121] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT Chiari malformation Type I (CM-I) with an associated spinal syrinx is a common pediatric diagnosis. A better understanding of the relative age-related prevalence and MR imaging characteristics of these associated conditions may lead to improved treatment decisions. METHODS The authors performed a retrospective review of 14,116 consecutive individuals 18 years of age or younger who had undergone brain or cervical spine MR imaging at the University of Michigan between November 1997 and August 2008. In the patients with CM-I, demographic, clinical, and radiographic information was recorded. RESULTS Five hundred nine children (3.6%) with CM-I were identified. Among these patients, 23% also had a spinal cord syrinx, and 86% of the syringes were found in the cervical spine. The MR imaging prevalence of CM-I with a syrinx was 1.2% in girls and 0.5% in boys (p < 0.0001). The severity of impaired CSF flow at the foramen magnum was associated with the amount of tonsillar herniation (p < 0.0001) and conformation of the tonsils (p < 0.0001). Patients with CM-I were treated surgically in 35% of cases; these patients exhibited more severe tonsillar herniation (p < 0.0001) and impaired CSF flow (p < 0.0001) as compared with those who did not undergo surgery. On imaging, 32% of all the patients with CM-I were considered symptomatic by the treating physician. Patients were more likely to be considered symptomatic if they were female, had a syrinx, displayed abnormal tonsillar pulsations, or had a greater amount of tonsillar herniation. CONCLUSIONS In this study the authors describe the age-related prevalence and MR imaging characteristics of CM-I and its association with a syrinx and other abnormalities in a large group of children who underwent MR imaging for any indication. Syringes are more common in older children, in girls, and in patients with a greater degree of tonsillar descent and CSF flow impairment.
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Affiliation(s)
- Jennifer Strahle
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Krieger MD, Falkinstein Y, Bowen IE, Tolo VT, McComb JG. Scoliosis and Chiari malformation Type I in children. J Neurosurg Pediatr 2011; 7:25-9. [PMID: 21194283 DOI: 10.3171/2010.10.peds10154] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The identification of Chiari malformations Type I (CM-Is) has increased in recent years, commonly during MR imaging for evaluation of a possible cause of scoliosis. The treatment of this abnormality remains controversial, and the expected success of treatment is unclear. The goal of the present study is to evaluate the effects of a craniotomy for CM-I decompression on scoliosis in children and adolescents. METHODS The authors conducted a 10-year retrospective review of pediatric patients who were found to have a CM-I during evaluation for scoliosis. Seventy-nine patients were identified, ranging in age from 6 months to 18 years (median 12 years). There were 42 girls (54%) and 37 boys (46%). All were noted on MR imaging to have hydrosyringomyelia of the spinal cord. Forty-nine patients had curvatures less than 20° prior to treatment. The other 30 patients had curves ranging from 25° to 80° and underwent orthopedic follow-up and treatment. None of these patients were referred for specific neurological complaints, but 12 (16%) had neurological signs on physical examination. All were treated with a craniocervical decompression in a standard fashion. Follow-up ranged from 6 to 93 months with a median of 35 months. Magnetic resonance images obtained at 6 months postoperatively and serial standing anteroposterior spine radiographs were used to evaluate outcomes. RESULTS On the MR images obtained 6 months postoperatively, 70 patients (89%) had a significant reduction in the syrinx with an associated ascent of the cerebellar tonsils. Persistent large syringes were treated with reoperation in 6 patients, and shunts were inserted for hydrocephalus in 2 patients. None of the 49 patients with curves less than 20° had progression of their curvature postoperatively. Of the 30 patients with curves greater than 25°, 9 had no change in the scoliosis or had a reduction in curve magnitude after Chiari decompression. This group required no further therapy and was effectively treated by Chiari decompression alone. Twenty-one patients required further scoliosis treatment after Chiari decompression; 12 required orthotic treatment, 11 received spinal instrumentation and fusion surgery, and 2 received orthoses followed by fusion and instrumentation. The severity of the curvature beyond 20° did not predict the need for spinal surgery. CONCLUSIONS This large series reports on the efficacy of treatment for scoliosis associated with a CM-I and syrinx in children. A CM-I decompression alone was adequate treatment for mild scoliosis of less than 20°. Patients with scoliosis greater than 20° required bracing and/or spinal fusion surgery 70% of the time in addition to the CM-I decompression.
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Affiliation(s)
- Mark D Krieger
- Division of Neurosurgery, Children’s Hospital Los Angeles,Department of Neurological Surgery, USC Keck School of Medicine, 1300 North Vermont Avenue, Los Angeles, CA 90027, USA.
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Hankinson T, Tubbs RS, Wellons JC. Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst 2011; 27:35-40. [PMID: 20890606 DOI: 10.1007/s00381-010-1295-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 09/23/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Few studies are available that directly compare dural opening with and without additional intradural maneuvers. Therefore, the current review analyzed the available literature regarding this topic. METHODS An Ovid MEDLINE search was completed using each of the terms "Chiari malformation," "syringomyelia," "syrinx," "syringohydromyelia" in combination with "child" or "pediatric." Publications were considered relevant if they reported the results of posterior fossa decompression without dural opening (PFD) to posterior fossa decompression with duraplasty (PFDD). The included studies were divided into three categories based upon the surgical techniques studied. The first group of papers included works that directly compared PFD to PFDD. The second group included studies in which all patients were treated with PFD. The third group included studies in which all patients were treated with PFDD. Three outcome parameters were assessed: (1) improvement of clinical signs/symptoms, (2) syrinx resolution, and (3) scoliosis progression. RESULTS At this time, there is no level I or IIa evidence comparing PFD with PFDD. The notions that PFDD has a lower rate of reoperation and that PFD has a lower rate of cerebrospinal fluid-related complications are both based on IIb/B evidence. CONCLUSIONS Prospective randomized trials are necessary for definitive comments regarding the success of PFD and PFDD.
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Affiliation(s)
- Todd Hankinson
- Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, Birmingham, AL 35233, USA
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Henderson FC, Wilson WA, Mott S, Mark A, Schmidt K, Berry JK, Vaccaro A, Benzel E. Deformative stress associated with an abnormal clivo-axial angle: A finite element analysis. Surg Neurol Int 2010; 1. [PMID: 20847911 PMCID: PMC2940090 DOI: 10.4103/2152-7806.66461] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/25/2010] [Indexed: 11/16/2022] Open
Abstract
Background: Chiari malformation, functional cranial settling and subtle forms of basilar invagination result in biomechanical neuraxial stress, manifested by bulbar symptoms, myelopathy and headache or neck pain. Finite element analysis is a means of predicting stress due to load, deformity and strain. The authors postulate linkage between finite element analysis (FEA)-predicted biomechanical neuraxial stress and metrics of neurological function. Methods: A prospective, Internal Review Board (IRB)-approved study examined a cohort of 5 children with Chiari I malformation or basilar invagination. Standardized outcome metrics were used. Patients underwent suboccipital decompression where indicated, open reduction of the abnormal clivo-axial angle or basilar invagination to correct ventral brainstem deformity, and stabilization/ fusion. FEA predictions of neuraxial preoperative and postoperative stress were correlated with clinical metrics. Results: Mean follow-up was 32 months (range, 7-64). There were no operative complications. Paired t tests/ Wilcoxon signed-rank tests comparing preoperative and postoperative status were statistically significant for pain, bulbar symptoms, quality of life, function but not sensorimotor status. Clinical improvement paralleled reduction in predicted biomechanical neuraxial stress within the corticospinal tract, dorsal columns and nucleus solitarius. Conclusion: The results are concurrent with others, that normalization of the clivo-axial angle, fusion-stabilization is associated with clinical improvement. FEA computations are consistent with the notion that reduction of deformative stress results in clinical improvement. This pilot study supports further investigation in the relationship between biomechanical stress and central nervous system (CNS) function.
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Affiliation(s)
- Fraser C Henderson
- Doctors Community Hospital, Georgetown University Hospital, United States
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Albert GW, Menezes AH, Hansen DR, Greenlee JDW, Weinstein SL. Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. J Neurosurg Pediatr 2010; 5:554-61. [PMID: 20515326 DOI: 10.3171/2010.3.peds09489] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECT The authors conducted a study to evaluate the unique presenting signs and symptoms of Chiari malformation Type I (CM-I) in children younger than 6 years of age and highlight the benefits of early surgical treatment in this patient population. METHODS The authors reviewed the medical records of patients who presented to the neurosurgery department before their 6th birthday and subsequently underwent surgery for CM-I. They identified 39 patients who had been evaluated between 1984 and 2007 and examined the medical records for presentation, surgical intervention, and outcome. RESULTS Children aged 0-2 years commonly presented with oropharyngeal dysfunction (77.8%). Children aged 3-5 years more frequently presented with syringomyelia (85.7%), scoliosis (38.1%), and/or headache (57.1%). All patients underwent posterior fossa craniectomy. Additionally, in many patients cervical laminectomy and/or duraplasty was performed. A few patients required transoral decompression and occipitocervical fusion. In most cases, surgery led to resolution or dramatic improvement of initial symptoms. CONCLUSIONS Early recognition and surgical treatment of CM-I in young children leads to good outcomes in the majority of patients. Additional therapies for oropharyngeal dysfunction, syringomyelia, and scoliosis can frequently be avoided.
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Affiliation(s)
- Gregory W Albert
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242, USA
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Abstract
Congenital spinal vertebral anomalies can present as scoliosis or kyphosis or both. The worldwide prevalence of the vertebral anomalies is 0.5-1 per 1000 live births. Vertebral anomalies can range from hemi vertebrae (HV) which may be single or multiple, vertebral bar with or without HV, block vertebrae, wedge shaped or butterfly vertebrae. Seventy per cent of congenital vertebral anomalies result in progressive deformities. The risk factors for progression include: type of defect, site of defect (junctional regions) and patient's age at the time of diagnosis. The key to success in managing these spinal deformities is early diagnosis and anticipation of progression. One must intervene surgically to halt the progression of deformity and prevent further complications associated with progressive deformity. Planning for surgery includes a preoperative MRI scan to rule out spinal anomalies such as diastematomyelia. The goals of surgical treatment for congenital spinal deformity are to achieve a straight growing spine, a normal standing sagittal profile, and a short fusion segment. The options of surgery include in situ fusion, convex hemi epiphysiodesis and hemi vertebra excision. These basic surgical procedures can be combined with curve correction, instrumentation and short segment fusion. Most surgeons prefer posterior (only) surgery for uncomplicated HV excision and short segment fusion. These surgical procedures can be performed through posterior, anterior or combined approaches. The advocates of combined approaches suggest greater deformity correction possibilities with reduced incidence of pseudoarthrosis and minimize crankshaft phenomenon. We recommend posterior surgery for curves involving only an element of kyphosis or modest deformity, whereas combined anterior and posterior approach is indicated for large or lordotic deformities. In the last decade, the use of growing rods and vertebral expandable prosthetic titanium rib has improved the armamentarium of the spinal surgeon in dealing with certain difficult congenital spinal deformities. The goal of growing rod treatment is to provide simultaneous deformity correction and allow for continued spinal growth. Once maximal spinal growth has been achieved, definitive fusion and instrumentation is performed.
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Affiliation(s)
- Ujjwal K Debnath
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - Vivek Goel
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - Nanjanduppa Harshavardhana
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - John K Webb
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
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Abstract
STUDY DESIGN To review diagnosis and treatment of neurogenic factors implicated in the development of progressive scoliosis. OBJECTIVE Increased awareness of neurogenic causes as a contributing component of spinal cord tethering has led to enhanced radiographic surveillance for etiologic factors contributing to the genesis of scoliosis. Review of various manifestations of spinal dysraphism offers better definition of clinical indications for surveillance MRI scans and thus may contribute to improving outcomes for affected individuals. SUMMARY OF BACKGROUND DATA Increasing utilization of surveillance MRI has led to a greater awareness of neurogenic causes as contributing factors in the setting of scoliosis. It is imperative for clinicians treating individuals with scoliosis to be aware of the most common etiologies of neurogenic factors as well as be cognizant of the neurosurgical approaches to treating these conditions in a pre-emptive fashion. This will serve to minimize potential neurological complications and offer improved surgical outcomes after instrumentation. METHODS Current therapeutic approaches were outlined for various etiologies of neurogenic scoliosis as well as neurosurgical management of the tethered cord, spinal cord tumors in addition to current challenges surrounding Chiari malformations and syringomyelia. RESULTS Timely recognition of these frequently progressive conditions may not only prevent irreversible neurologic compromise but may also help to ameliorate or stabilize concurrent scoliosis. Tethered cords are best treated by releasing the affected cord and offers the best opportunity to stabilize or improve the scoliosis. Syringomyelia, often associated with a Chiari malformation, is a well-known progenitor of scoliosis, and addressing the underlying cause with a Chiari decompression frequently leads to a reduction or resolution of the syrinx and may result in a concomitant improvement in scoliosis. CONCLUSION Surveillance MRI should be undertaken for scoliosis when there are clinical indications consistent for a tethered cord, spinal cord tumor, or Chiari malformation and associated syringomyelia.
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Ono A, Suetsuna F, Ueyama K, Yokoyama T, Aburakawa S, Takeuchi K, Numasawa T, Wada K, Toh S. Cervical spinal motion before and after surgery in patients with Chiari malformation type I associated with syringomyelia. J Neurosurg Spine 2007; 7:473-7. [PMID: 17977187 DOI: 10.3171/spi-07/11/473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There have been few reports about the cervical spinal motion in patients with Chiari malformation Type I (CM-I) associated with syringomyelia. To investigate this phenomenon, the relationship between the preoperative cervical range of motion (ROM) and the stage of cerebellar tonsillar descent as well as the cervical ROM before and after foramen magnum decompression (FMD) were evaluated. METHODS Thirty patients who had CM-I associated with syringomyelia and who underwent FMD participated in the study. The ROM and lordosis angle of the cervical spine were measured on x-ray films. In addition, the relationship between preoperative degree of cerebellar tonsillar descent and the ROM between the levels of the occiput (Oc) and C2 was investigated. RESULTS The mean flexion-extension ROM at Oc-C2 was 15.5 degrees before and 14.1 degrees after surgery, and the mean flexion-extension ROM of C2-7 was 55.1 degrees before and 52.8 degrees after surgery. The mean pre- and postoperative lordosis angles at C2-7 were 16.8 and 19.1 degrees, respectively. There was no significant difference between the values measured before and after surgery. There was no correlation between the degree of cerebellar tonsillar descent and the ROM at Oc-C2. CONCLUSIONS. Foramen magnum decompression is an excellent surgical technique that has no effect on the postoperative cervical ROM and cervical alignment.
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Affiliation(s)
- Atsushi Ono
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Japan.
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Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst 2007; 23:1239-50. [PMID: 17639419 DOI: 10.1007/s00381-007-0428-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND Both the diagnosis and treatment regimens for the Chiari I malformation (CIM) are varied and controversial. The present paper analyzes the literature regarding this form of hindbrain herniation in regard to definition, anatomy, pathobiology, symptoms, findings, treatment, and outcomes. DISCUSSIONS Appropriate literature germane to the CIM is reviewed and discussed. There is variation in the reported anatomy, outcome, and treatment for children with CIM. Based on the literature, most patients have preoperative symptoms or findings (e.g., syringomyelia) improve no matter what surgical technique is utilized. However, standardized treatment paradigms based on randomized controlled studies are still necessary to elucidate the optimal selection and treatment criteria.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, University of Alabama at Birmingham, 1600 7th Avenue South ACC 400, Birmingham, AL 35233, USA.
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Bradley LJ, Ratahi ED, Crawford HA, Barnes MJ. The outcomes of scoliosis surgery in patients with syringomyelia. Spine (Phila Pa 1976) 2007; 32:2327-33. [PMID: 17906574 DOI: 10.1097/brs.0b013e3181557989] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of a consecutive case series. OBJECTIVE To describe patient demographics, syrinx morphology, and deformity characteristics, as well as postsurgical correction, progression, and complications. SUMMARY OF BACKGROUND DATA Conflicting data are available on the natural and postsurgical history of patients with spinal deformity associated with syringomyelia. This is the largest series in the literature on the surgical outcomes of these patients. METHODS All patients treated for spinal deformity at our institution with an associated syrinx were reviewed. Demographics, deformity morphology, treatment methods, and postoperative outcomes were measured and recorded. RESULTS Thirteen patients met inclusion criteria. All were Lenke thoracic modifier normal or positive. Ten patients underwent neurosurgical decompression. All curves either progressed or remained unchanged following neurosurgical treatment. The average thoracic kyphosis measured 46 degrees (29 degrees-69 degrees). Thoracic kyphosis was significantly increased compared with a population of adolescent idiopathic patients (P = 0.00002). The average curve before scoliosis surgery was 71 degrees (31 degrees-119 degrees) in the coronal plane and 46 degrees (29 degrees-68 degrees) in the sagittal plane. The average correction from the initial scoliosis surgery was 48% (6%-83%). All patients had spinal cord monitoring or wake-up tests during surgery. There were no instances of spinal cord injury from surgery. Three patients progressed significantly following anterior fusion, 2 of whom required further corrective surgery. Following arthrodesis, 4 patients progressed >10 degrees during follow-up. CONCLUSION The lack of thoracic hypokyphosis seen in idiopathic-like curves is a strong indicator of a possible underlying syrinx. Neurosurgical treatment of the syrinx did not improve the scoliosis. Caution should be exercised when choosing fusion levels, and arthrodesis should be planned with the underlying pathology in mind. Scoliosis surgery has proven to be safe in patients with treated syrinx when spinal cord monitoring or wake-up tests are used.
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Affiliation(s)
- Lyndon J Bradley
- Department of Paediatric Spine, Starship Children's Hospital, Auckland, New Zealand.
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Abstract
Abstract
OBJECTIVE
Spine deformities, notably scoliosis, are known to occur in conjunction with syringomyelia. This study aims to analyze the effect of laminectomies performed in the course of treatment of syringomyelia. It examines the incidence, severity, and type of spine deformity as it relates to the extent and location of laminectomies performed.
METHODS
Records of 169 patients were analyzed for evidence of spinal deformity on imaging studies for the extent of the syringomyelic cavities and for previous surgical procedures on the spine. This analysis included patients with syringomyelia related to Chiari malformation, as well as patients with primary spinal pathology.
RESULTS
Spinal deformities were encountered in 41% of Chiari-syringomyelia patients who had not undergone previous surgery and in 57% of such patients who underwent reoperation. Scoliosis, the most common type of deformity encountered, was likely to be mild in patients who had not undergone previous surgery and severe in reoperated patients. Spine deformity was significantly more common in those patients who had more extensive bone removal.
CONCLUSION
Complete laminectomy should be avoided whenever possible in patients with syringomyelia because local denervation of the axial musculature, added to loss of medial anterior horn cells from syringomyelia, favors the development of spine deformities. This is particularly true of laminectomies performed at the junctional areas of the spine, i.e., cervical-thoracic and thoracolumbar. Hemilaminectomy usually suffices for shunt placement; instrumented stabilization should be considered in patients undergoing full laminectomy, especially those considered to be at high risk of developing deformity.
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Affiliation(s)
- Ulrich Batzdorf
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-6901, USA.
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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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Affiliation(s)
- Behrooz A Akbarnia
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Drive, Suite #300, La Jolla, CA 92037, USA.
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Tubbs RS, Doyle S, Conklin M, Oakes WJ. Scoliosis in a child with Chiari I malformation and the absence of syringomyelia: case report and a review of the literature. Childs Nerv Syst 2006; 22:1351-4. [PMID: 16532361 DOI: 10.1007/s00381-006-0079-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scoliosis is a common finding in children with Chiari I malformation and syringomyelia. The development of scoliosis associated with a Chiari malformation typically has been ascribed to the presence of syringomyelia. Decompression of the hindbrain hernia will often alleviate the syringomyelia and, in many cases, stabilize or reverse the scoliosis. CASE REPORT We report a child with Chiari I malformation and scoliosis who presented with Valsalva-induced headache/neck pain. MRI revealed no syringomyelia or hydrocephalus. Radiographs revealed that her scoliotic curvature was approximately 13 degrees and was a single levoscoliotic curve. This patient underwent a posterior fossa decompression with duraplasty for her Valsalva-induced pain. Postoperatively, she had resolution of her pain and there has been no progression of her scoliosis at 3 years follow-up. PROGNOSIS Intriguingly, and scattered throughout the medical literature, many have noted cases of scoliosis in patients with only a Chiari I malformation and no syringomyelia. Moreover, experimental studies have induced scoliosis in animals after compression of the dorsal columns. After a review of the medical literature regarding a potential cause and effect of herniated hindbrain-induced scoliosis in the absence of syringomyelia, this association although rare, does seem plausible.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
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El-Hawary R, Sucato DJ, Sparagana S, McClung A, Van Allen E, Rampy P. Spinal cord monitoring in patients with spinal deformity and neural axis abnormalities: a comparison with adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 2006; 31:E698-706. [PMID: 16946643 DOI: 10.1097/01.brs.0000232707.98076.37] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of spinal cord monitoring (SCM) results of patients with neural axis abnormalities (NAA) as compared with a control group of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To analyze SCM on a group of patients who had a NAA undergoing spinal deformity surgery. SUMMARY OF BACKGROUND DATA To our knowledge, only 1 report in the literature has analyzed the accuracy and reliability of SCM in patients with NAA. METHODS Over a 10-year period, 41 patients with NAA had SCM while undergoing surgery for spinal deformity. These patients were retrospectively compared with a group of 136 AIS patients. RESULTS The average ages were similar (14.4 vs. 14.6 years), but there were more males (48.8% vs. 19.1%) and greater preoperative curve magnitude in the NAA group (65.9 degrees vs. 59.8 degrees ) (P < 0.05). Good baseline values were achieved less often in the NAA group for somatosensory-evoked potentials (SSEP) (85.4% vs. 98.5%) and motor-evoked potentials (MEP) (82.6% vs. 100%) (P < 0.05). Significant deviations from baseline values were seen more often in the NAA group for SSEP (8.6% vs. 1.5%) and MEP (5.3% vs. 2.5%). There were no false negatives in either group. CONCLUSIONS SCM in patients who have NAA can be more difficult to obtain than in AIS but results in few false positives and does not miss neurologic injury.
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Affiliation(s)
- Ron El-Hawary
- Isaac Walton Killam Health Centre, Halifax, Nova Scotia, Canada
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Hamlat A, Adn M, Ben Yahia M, Morandi X, Brassier G, Guegan Y. Gowers intrasyringal hemorrhage. Case report and review of the literature. J Neurosurg Spine 2006; 3:477-81. [PMID: 16381211 DOI: 10.3171/spi.2005.3.6.0477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concept of hemorrhage in a preexisting syringomyelic cavity was first described by Gowers in 1904. Since its first description only 13 cases have been reported. The aims of this report are to describe a new case, bring this entity to wider attention, and summarize the existing literature on the subject. This 36-year-old woman presented with progressive gait disturbance and unsteadiness. Physical examination revealed incomplete quadriparesis, predominantly on the left side, and hypesthesia below C-7. Magnetic resonance imaging revealed hematomyelia characterized by a heterogeneous hyperintense signal within the central cervical cord. A liquefied well-limited hematoma was evacuated. The postoperative course was uneventful; a near-complete recovery was observed at the 7-year follow-up examination. Most cases of intrasyringal hemorrhage (ISH) have occurred in syringomyelic cavities associated with scoliosis or Chiari malformation Type I. Although there is no specific clinical picture associated with this entity, it can be characterized by three neurological forms: 1) sudden onset or rapid development of signs and symptoms, 2) acute worsening of symptoms that may improve but leaving greater neurological dysfunction than before the previous episode, and 3) ISH may initiate progressive deterioration in a patient with known syringomyelia. Intrasyringal bleeding is most probably caused by a sudden dilation of the syringomyelic cavity, which may provoke rupture of the intrasyringal vessels by an acute distension of the accompanying strands. Magnetic resonance imaging is the most accurate diagnostic modality, and recognition of ISH can lead to early, safe, and efficient surgical treatment.
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Hamlat A, Le Strat A, Boisselier P, Brassier G, Carsin-Nicol B. Asymptomatic syringomyelia in the course of medulloblastoma. Pediatr Neurosurg 2005; 41:258-63. [PMID: 16195679 DOI: 10.1159/000087485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 04/26/2005] [Indexed: 11/19/2022]
Abstract
Syringomyelia is frequently associated with Chiari malformation or one of many other pathological conditions. Its co-occurrence with medulloblastoma is rare, and to our knowledge, only 4 patients have been reported, although some reports have documented on syringomyelia associated with intracranial processes or intramedullary tumor. The authors describe an unusual case of asymptomatic thoracic syringomyelia complicated by an intrasyringal hemorrhage in a child with medulloblastoma. This report illustrates that, although unusual, syringomyelia is a potential complication in the natural history of medulloblastoma, and the authors consider the possible pathogenesis of syrinx enlargement.
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Davids JR, Chamberlin E, Blackhurst DW. Indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis. J Bone Joint Surg Am 2004; 86:2187-95. [PMID: 15466727 DOI: 10.2106/00004623-200410000-00009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of magnetic resonance imaging has led to the diagnosis of abnormalities of the central nervous system associated with apparent idiopathic scoliosis. The indications for magnetic resonance imaging for presumed adolescent idiopathic scoliosis have not been established. METHODS One thousand, two hundred and eighty children with presumed adolescent idiopathic scoliosis were evaluated over a ten-year period. Magnetic resonance imaging of the central nervous system (brainstem and spinal cord) was performed for specific patients, on the basis of the presence of selected indicators determined from the clinical history, physical examination, and plain radiographic examination of the spine. The medical records were reviewed to determine the specific indicators, the results of the imaging studies, and the subsequent treatment. RESULTS Magnetic resonance imaging was ordered for 274 (21%) of the 1280 children who were evaluated. Abnormal findings were seen in twenty-seven (10%) of the 274 patients who underwent imaging, or 2% of the entire cohort. The most valuable single indicator of an abnormal finding on magnetic resonance imaging was absence of thoracic apical segment lordosis: eight of thirty-nine patients with that indicator had an abnormal finding on magnetic resonance imaging. The optimal diagnostic yield for a single category of indicators occurred when an atypical curve pattern was the only indicator: six of fifty-eight patients in whom this was the case had an abnormal finding on magnetic resonance imaging. None of the twenty children in whom pain was the only indicator category had an abnormal imaging study. The optimal diagnostic yield occurred when both an atypical curve pattern and neurological indicators were present: thirteen (25%) of fifty-three patients in whom this was the case had an abnormal finding on magnetic resonance imaging. Thirteen of the twenty-seven patients received surgical treatment for the abnormality of the central nervous system revealed by the imaging. CONCLUSIONS The correct use of diagnostic tests is an important component of effective medical practice. An abnormality of the central nervous system is present in approximately 10% of patients with presumed adolescent idiopathic scoliosis in whom only subtle abnormalities are identified on the basis of the clinical history, physical examination, or radiographic examination. Knowledge of the diagnostic value of the specific clinical indicators, considered individually and in combination, can help the clinician to determine more effectively when advanced imaging of the central nervous system should be performed.
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Affiliation(s)
- Jon R Davids
- Motion Analysis Laboratory, Shriners Hospital for Children, 950 West Faris Road, Greenville, SC 29605, USA.
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Morcuende JA, Dolan LA, Vazquez JD, Jirasirakul A, Weinstein SL. A prognostic model for the presence of neurogenic lesions in atypical idiopathic scoliosis. Spine (Phila Pa 1976) 2004; 29:51-8. [PMID: 14699276 DOI: 10.1097/01.brs.0000105526.65485.92] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Consecutive series of patients with idiopathic scoliosis with atypical features. OBJECTIVES The purpose of this study is to define a specific yet sensitive set of signs and symptoms to indicate the use of MRI in patients with atypical idiopathic scoliosis. Specifically, this study empirically defines a new diagnostic test for the presence of neurogenic lesions based on clinical and radiologic data and then reports the properties of this test in relation to MRI as the gold standard. SUMMARY OF BACKGROUND DATA The reported prevalence of brain stem and spinal cord abnormalities in patients with idiopathic scoliosis associated with atypical features varies from 0% to 60%. This wide range most likely results from the fact that the samples studied are either not well defined or are heterogeneous across studies. Because of these issues, the likelihood of neurogenic lesions in atypical idiopathic scoliosis is not known; consequently, the decision to order an MRI is controversial.METHODS A total of 1,206 patients coded as having idiopathic scoliosis were identified from our institutional database. Of these, 72 patients had one or more atypical features: early-onset scoliosis, atypical curve, severe curve despite immaturity (>45 degrees ), rapidly progressive curve (>1 degrees per month), back pain, headache, or neurologic abnormalities on clinical examination. All 72 patients underwent brain and spinal cord MRI. Logistic regression was used to determine significant predictors of positive MRI and to define the prognostic model. RESULTS Eleven patients (15%) had abnormal findings on MRI. Eight had an Arnold-Chiari type I malformation associated with a syrinx; 1 had an Arnold-Chiari type I malformation; 1 a syrinx; and 1 a cervical syrinx with a conus lipoma. MRI was positive in 5 of 9 patients (55%) with severe curves despite immaturity. Twenty patients had one or more abnormal neurologic signs. Of these, 8 (40%) had a positive MRI, while only 3 of the 52 patients (6%) with a normal neurologic examination (but other atypical features) had a positive MRI. The most predictive model included the variables neurologic abnormalities (yes or no) and severe curve despite immaturity (yes or no). Using this model, patients with atypical characteristics other than severe curvatures or abnormal neurologic abnormalities(s) had a 3% probability (95% confidence interval [CI], 1-12%) of having a positive MRI; patients with abnormal neurologic change(s), but a nonsevere curve, had a 29% probability of a positive MRI (95% CI, 12-53%) and patients with severe curves and no neurologic change(s) had a 32% probability of positive MRI (95% CI, 8-71%). Patients with both a severe curve and abnormal neurologic change(s) had an 86% probability of positive MRI (95% CI, 46-98%). Agreement between this test and the MRI was 75%, with a sensitivity of 82% (95% CI, 48-97%) and a specificity of 74% (95% CI, 61-83%). CONCLUSIONS The model derived in this study indicates that the probability of neurogenic lesions is extremely low in most patients with idiopathic scoliosis with atypical features. However, patients with severe curves despite skeletal immaturity and an abnormal neurologic examination have a significant probability of neurogenic lesions. Therefore, clinical efficiency will be enhanced by narrowing the indications for MRI to those patients with these risk factors.
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Affiliation(s)
- José A Morcuende
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA
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Brockmeyer D, Gollogly S, Smith JT. Scoliosis associated with Chiari 1 malformations: the effect of suboccipital decompression on scoliosis curve progression: a preliminary study. Spine (Phila Pa 1976) 2003; 28:2505-9. [PMID: 14624085 DOI: 10.1097/01.brs.0000092381.05229.87] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of the effect of suboccipital decompression and duraplasty on curve progression in 22 patients who presented with scoliosis, syringomyelia, and a Chiari 1 malformation. OBJECTIVES To document the clinical characteristics of scoliosis in association with a Chiari 1 malformation, determine the effects of suboccipital decompression and duraplasty on scoliosis curve progression over time, and identify the clinical factors (age, gender, and curve characteristics) that may be associated with a clinical improvement in the scoliotic deformity after suboccipital decompression. SUMMARY OF BACKGROUND DATA Prior publications have documented the clinical characteristics, signs, and symptoms of the Chiari 1 malformation. An association between Chiari 1 malformations, syringomyelia, and scoliosis has been recognized and reported. Several authors have also reported on the response of the scoliotic curve to Chiari 1 decompression, but the number of patients in these reports has been small. This cohort represents the largest number of patients to date (21) with Chiari 1 malformations, syringomyelia, and scoliosis who have been treated and followed over time in order to determine the effect of decompression on curve progression. METHODS A retrospective case review of 85 patients, age 16 years or less, who underwent posterior fossa decompression for a Chiari 1 malformation between 1990 and November 2000. A subset of 7 males and 15 females (22 of 85 total patients) who initially presented with scoliosis and were then found to have a Chiari 1 malformation was selected from this larger cohort for further review. The orthopedic and neurosurgical charts, spinal radiographs, and magnetic resonance imaging scans were then reviewed for each of these patients. RESULTS Twenty-one of the 22 patients who presented with scoliosis met the inclusion criteria of having a Chiari 1 malformation, scoliosis, and an unfused spine during the follow-up period after suboccipital decompression. One patient had a posterior spinal fusion before suboccipital decompression and was excluded from further review. CONCLUSIONS Thirteen patients of the 21 study patients (62%) had curve improvement or stabilization during the follow-up period. Eight of 21 patients (38%) had curve progression. Closer analysis reveals that the age, gender, and initial size of the scoliotic curve influenced the results of suboccipital decompression on the behavior of the scoliosis. Specifically, 10 of 11 patients (91%) who were less than 10 years of age at the time of suboccipital decompression have had their curves improve or stay the same during follow-up. In contrast, 5 of 7 female patients (72%) older than 10 years old with a curve greater than 40 degrees before suboccipital decompression have either been fused or are awaiting fusion.
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Affiliation(s)
- Douglas Brockmeyer
- Department of Neurosurgery, University of Utah and Primary Children's Medical Center, Salt Lake City, Utah 84113-1103, USA.
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Hausmann ON, Böni T, Pfirrmann CWA, Curt A, Min K. Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2003; 12:501-6. [PMID: 12905054 PMCID: PMC3468007 DOI: 10.1007/s00586-003-0568-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2002] [Revised: 02/08/2003] [Accepted: 04/12/2003] [Indexed: 11/30/2022]
Abstract
This is a prospective study of spinal magnetic resonance imaging (MRI), electrophysiological recordings, and neurological examinations of 100 patients admitted for surgery for adolescent idiopathic scoliosis (AIS), which was conducted to assess the prevalence of structural and functional abnormalities within the spinal cord in patients with clinically normal neurologic condition. In all patients the clinical diagnosis and intact neurological condition was ascertained by a spinal orthopedic surgeon. Full-length spinal axis MRI studies (T1/T2 sequences) and somato-sensory evoked potentials of the tibial nerves (tSSEPs) were preoperatively assessed by independent evaluators blinded to the patients' medical histories. Structural spinal cord abnormalities were found in three of 100 AIS patients on MR imaging. In one patient a Chiari malformation type 1 with an accompanying syringomyelia was diagnosed, which required a suboccipital decompression. In the other two patients small thoracic syringomyelias were diagnosed. Abnormalities of spinal cord function were detected in 68% of the 100 patients: tSSEP latencies corrected for body height were increased in 56% of the patients; pathological differences between tSSEPs on the left and right sides were present in 17% (12% in combination with a prolongation of the latency). The findings of this study indicate that MRI and electrophysiological examinations are essential to assess spinal cord abnormalities that are clinically not detectable in AIS patients. Even in patients with intact neurologic condition and clinically typical right-curved thoracic scoliosis, the possibility of intraspinal pathologies should be ruled out by MRI. It is especially important to detect structural pathologies like syringomyelia and Chiari malformation before proceeding with scoliosis surgery, as these conditions are associated with a higher neurological risk during scoliosis surgery. The electrophysiological recordings made in the present study, with the high number of pathological tSSEPs, are indicative of functional abnormalities with a subclinical involvement of the recorded neuronal pathways. The relevance of the latter findings is not yet clear, but pre-operative tSSEP examinations offer the possibility of assessing alterations in spinal cord function that are undetectable by clinical examination.
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Affiliation(s)
- Oliver N. Hausmann
- Department of Orthopedic Surgery, University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopedic Surgery, University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008 Zurich, Switzerland
| | | | - Armin Curt
- ParaCare, Swiss Paraplegic Center, University Hospital Balgrist, University of Zürich, Switzerland
| | - Kan Min
- Department of Orthopedic Surgery, University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008 Zurich, Switzerland
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Greenlee JDW, Donovan KA, Hasan DM, Menezes AH. Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years. Pediatrics 2002; 110:1212-9. [PMID: 12456921 DOI: 10.1542/peds.110.6.1212] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The entity of hindbrain herniation without myelodysplasia in the very young child has been poorly described. A retrospective analysis of children diagnosed with Chiari I malformation (CM I) before their sixth birthday is presented. METHODS Since 1985, 31 children with CM I (0.3-5.8) years of age have been diagnosed at University of Iowa Hospitals and Clinics. Their records were reviewed for presenting symptoms, signs, radiographic findings, treatment, complications, and outcome. RESULTS The average age at diagnosis was 3.3 years. Sixteen patients were under age 3. Chief presenting complaints included impaired oropharyngeal function (35%), scoliosis (23%), headache or neck pain (23%), sensory disturbance (6%), weakness (3%), and other (10%). Sixty-nine percent of children under age 3 had abnormal oropharyngeal function. Three patients under age 3 (19%) had undergone fundoplication and/or gastrostomy before diagnosis of CM I. Common physical findings included abnormal tendon reflexes (68%), scoliosis (26%), abnormal gag reflex (13%), and normal examination (13%). Vocal cord dysfunction (26%, all under age 3) and syringohydromyelia (52%) were also seen. Twenty-five patients were treated surgically at our institution with posterior fossa decompression, duraplasty, and cerebellar tonsillar shrinkage. Three patients were lost to follow-up. Ninety-one percent of patients reported improved symptomatology at last follow-up (mean: 3.9 years). Three patients required reoperation for recurrence of symptoms. Syringomyelia improved in all patients. Scoliosis resolved in 2 of 8 patients, improved in 5, and stabilized in 1. There was no permanent morbidity from surgery. DISCUSSION We show that children with Chiari I abnormality are very likely to present with oropharyngeal dysfunction if under age 3, and either scoliosis or headache or neck pain worsened by valsalva if age 3 to 5. These symptoms are very likely to improve after Chiari decompression, which can be done with low morbidity. CONCLUSIONS Very young children presenting with oropharyngeal dysfunction, pain worsened by valsalva, or scoliosis should prompt the clinician to consider CM I as a possible cause.
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Affiliation(s)
- Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Dobbs MB, Lenke LG, Szymanski DA, Morcuende JA, Weinstein SL, Bridwell KH, Sponseller PD. Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis. J Bone Joint Surg Am 2002; 84:2230-4. [PMID: 12473713 DOI: 10.2106/00004623-200212000-00016] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images. METHODS The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed. The inclusion criteria included presumed idiopathic scoliosis at the time of presentation, an age of three years or less, a curve magnitude of > or = 20 degrees, normal neurological findings, no associated syndromes, and no congenital abnormalities. All patients were evaluated with a total spine magnetic resonance imaging protocol for examination of neural axis abnormalities from the skull to the coccyx. RESULTS Ten (21.7%) of the forty-six patients were found to have a neural axis abnormality on magnetic resonance imaging. This group included five patients with an Arnold-Chiari malformation and an associated cervicothoracic syrinx, three with syringomyelia, one with a low-lying conus, and one with a brainstem tumor. Eight of these ten patients needed neurosurgical intervention for treatment of the abnormality. CONCLUSIONS The 21.7% prevalence of neural axis abnormalities in this group of patients with infantile idiopathic scoliosis was found to be almost identical to that reported in the literature on patients with juvenile idiopathic scoliosis. Because of the high prevalence of abnormalities and the fact that eight of the ten patients with abnormal findings on magnetic resonance images required neurosurgical intervention, a total spine magnetic resonance imaging evaluation at the time of presentation is recommended for all patients with infantile idiopathic scoliosis who have a curve measuring > or = 20 degrees.
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Affiliation(s)
- Matthew B Dobbs
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Luis, Missouri 63110, USA.
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Farley FA, Puryear A, Hall JM, Muraszko K. Curve progression in scoliosis associated with Chiari I malformation following suboccipital decompression. JOURNAL OF SPINAL DISORDERS & TECHNIQUES 2002; 15:410-4. [PMID: 12394666 DOI: 10.1097/00024720-200210000-00011] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nine children with scoliosis and Chiari I malformations were followed 1-11 years after suboccipital decompression. Eight also had syringomyelia. Despite initial curve stabilization, at final follow-up eight curves were of the magnitude to require spinal fusion. Neither bracing nor secondary neurosurgical procedures arrested progressive curves.
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Affiliation(s)
- Frances A Farley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, USA.
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