ABSTRACT: To analyze the clinical features of scoliosis associated with Chiari I malformation in adolescent patients, and to explore the validity and safety of one-stage posterior approach and vertebral column resection for the correction of severe scoliosis.
Between October 2004 and August 2008, 17 adolescent patients with scoliosis associated with Chiari I malformation were treated with surgical correction through posterior approach and pedicle instrumentation. There were 9 males and 8 females with an average age of 15.1 years (range, 12-19 years). The MRI scanning showed that 16 of 17 patients had syringomyelia in cervical or thoracic spinal cord. Apex vertebra of scoliosis were located at T7-12. One-stage posterior vertebral column resection and instrumental correction were performed on 9 patients whose Cobb angle of scoliosis or kyphosis was more than 90 degrees, or who was associated with apparent neurological deficits (total spondylectomy group). Other 8 patients underwent posterior instrumental correction alone (simple correction group). All patients' fixation and fusion segment ranged from upper thoracic spine to lumbar spine.
The operative time and the blood loss were (384 +/- 65) minutes and (4 160 +/- 336) mL in total spondylectomy group, and were (246 +/- 47) minutes and (1 450 +/- 213) mL in simple correction group; showing significant differences (P < 0.05). In total spondylectomy group, coagulation disorder occurred in 1 case, pleural perforation in 4 cases, and lung infection in 1 case. In simple correction group, pleural perforation occurred in 1 case. These patients were improved after symptomatic treatment. All patients were followed up 24-36 months (32.5 months on average). Bony healing was achieved at 6-12 months in total spondylectomy group. No breakage or pulling-out of internal fixator occurred. The angles of kyphosis and scoliosis were significantly improved at 1 week after operation (P < 0.01) when compared with those before operation. The correction rates of scoliosis and kyphosis (63.4% +/- 4.6% and 72.1% +/- 5.8%) in total spondylectomy group were better than those (69.4% +/- 17.6% and 48.8% +/- 19.3%) in simple correction group.
Suboccipital decompression before spine deformity correction may not always be necessary in adolescent scoliosis patients associated with Chiari I malformation. In patients with severe and rigid curve or apparente neurological deficits, posterior vertebral column resection would provide the opportunity of satisfied deformity correction and decrease the risk of neurological injury connected with surgical correction.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2010; 24(12):1489-93.