Surgical treatment of scoliosis associated with syringomyelia with no or minor neurologic symptom

• Published in: European spine journal Vol. 24; no. 7; pp. 1555 - 1559
• Main Authors: Zhang, Zhen-xing, Feng, Dong-xu, Li, Peng, Zhou, Hai-zhen, Liu, Tuan-jiang, Hui, Hua, Hao, Ding-jun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2015; Springer Nature B.V
• Subjects: Adolescent; Arnold-Chiari Malformation - complications; Arnold-Chiari Malformation - pathology; Child; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neural Tube Defects - complications; Neural Tube Defects - pathology; Neurosurgery; Neurosurgical Procedures; Original Article; Orthopedic Procedures; Radiography; Retrospective Studies; Scoliosis - complications; Scoliosis - diagnostic imaging; Scoliosis - surgery; Surgical Orthopedics; Syringomyelia - complications; Syringomyelia - pathology; Treatment Outcome; Young Adult; Syringomyelia; Scoliosis; Intraspinal abnormality; Surgical treatment
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-014-3692-1

Purpose Syringomyelia with coexisting intraspinal abnormities is thought to increase the risk of neurologic injury during surgical correction of the scoliosis. However, surgical treatment for intraspinal abnormities carries significant morbidity risks including worsening neurological function and wound complications. The authors’ aim in this study was to evaluate one-stage posterior correction of scoliosis in this patient population without prophylactic surgical treatment for neural axis malformations before scoliosis correction. Methods A total of 29 patients with syringomyelia and coexisting intraspinal abnormities who underwent scoliosis correction were evaluated. The average age was 15.6 years (range 12–23). All patients were examined for neural axis abnormalities using MRI, including syringomyelia with Chiari I malformation in 18 patients, syringomyelia with tethered cord and/or diastematomyelia in 11. None of patients presented with symptoms suggesting significant neurological dysfunction. The surgical efficacies and complications of correction were reviewed. Results The preoperative Cobb angle of major coronal curve averaged 65° (range 46°–95°), and it measured 28° (range 22°–43°) at the last follow-up, for a 63 % correction. Maximal kyphosis averaged 52° (range 41°–69°) preoperatively, and improved to 29° (range 22°–43°) at ultimate follow-up, for a 46 % correction. The average follow-up was 6 years (4–8 years). None of the patients experienced deterioration in their neurologic status. Conclusion The study results suggested that prophylactic neurosurgery for intraspinal abnormality may be unnecessary in patients with asymptomatic or minor symptomatic syringomyelia and coexisting intraspinal abnormities. One-stage posterior correction of scoliosis in this patient population does not involve significant complications and seems to be an alternative and safe treatment option.