Clinical manifestation and treatment strategy of scoliosis associated with Chiari malformation and/or syringomyelia
- VernacularTitle:脊柱侧凸伴发Chiari畸形和(或)脊髓空洞的手术治疗
- Author:
Yong QIU
;
Bin WANG
;
Zezhang ZHU
- Publication Type:Journal Article
- Keywords:
Scoliosis;
Syringomyelia;
Decompression,surgical;
Orthopedic fixation devices
- From:
Chinese Journal of Orthopaedics
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the clinical manifestation and the treatment strategy of the scoliosis associated with Chiari malformation and /or syringomyelia. Methods Fifty-two cases suffered from scoliosis with Chiari malformation and /or syringomyelia were divided into three groups for surgical treatment: 1) Group 1: 18 cases had scoliosis with Chiari Ⅰmalformation and /or syringomyelia without obvious neurologic impairment, their scoliosis was corrected with posterior instrumentation, but their Chiari Ⅰmalformation and syringomyelia were left untreated surgically. 2) Group 2: 12 patients, whose scoliosis was not indicated for surgery but those Chiari malformation associated with syringomyelia, underwent posterior sub-occipital craniectomy to enlarge foramen occipital magnum, C1 posterior arch decompression, duraplasty and syrinx-subarachnoid space shunting no matter whether neurologic deficits were present or not. 3) Group 3: 22 cases in addition of correction of scoliosis, due to neurologic deficits caused by Chiari Ⅰmalformation or syringomyelia, two-stage surgery was indicated: firstly, with posterior suboccipital craniectomy to enlarge foramen occipital magnum, C1 posterior arch decompression, duraplasty and syrinx-subarachnoid space shunting 6 months later, then underwent the scoliosis correction with instrumentation. Results In 34 patients who underwent craniovertebral decompression, only 6 of the 24 cases with preoperatively neurologic deficits achieved mild improvement within 6 months postoperatively. In 40 patients who were treated with posterior correction for scoliosis, the average frontal correction was 63% and the average sagittal correction was 80% for scoliosis less than 90?, the average frontal correction was 49% and the average sagittal correction was 74% for scoliosis more than 90?. At a follow-up of 6 months to 5 years, the average loss of the frontal correction was 6%. Conclusion Scoliosis associated with Chiari malformation and /or syringomyelia can be effectively treated with the similar results, as for adolescent idiopathic scoliosis. The mainstay for diagnosis is MR imaging. Accurate diagnosis and proper treatment for Chiari malformation or syringomyelia before scoliosis surgery will improve the rate of scoliosis correction, decrease the neurological complications.
