Does scoliosis in children improve following surgery for CM-I and syringomyelia? Attenello and colleagues recently published their results in a study of 21 children.
The authors reviewed the Johns Hopkins Hospital records from 1995-2005 of children undergoing first-time posterior fossa decompression for CM-I. Of the 258 children identified, 33 children (13%) had CM-I and scoliosis. Children undergoing posterior fossa decompression and concurrent spinal fusion were excluded. Twenty-one children treated by posterior fossa decompression for CM-I were available for review.
Mean age of the children was 9 years (range 6-12 y). Indications for surgery were 5 of more mm of tonsillar herniation (
a conservative measure, see abstract on Chiari 0), and either Chiari symptoms or syringomyelia with scoliosis greater than 10 degrees. Posterior fossa craniectomy and C1 laminectomy was performed in all 21 children.
The majority also underwent duraplasty. Duraplasty was not performed in patients with minimal tonsillar ectopia and evidence of physiological hindbrain cerebrospinal fluid flow and tonsillar pulsations on intraoperative ultrasonography after decompression.
Results
The scoliosis curve improved after surgery in 38% of the children and progressed in 48%. The remaining showed no change. Scoliosis was more likely to progress in children with thoracolumbar scoliosis that in those with just thoracic or lumbar scoliosis. It was also more likely to progress if the syrinx did not decrease in size after surgery.
In the only child in this group that did not have a duraplasty, the syrinx did not decrease and the scoliosis progressed.
Conclusions
The good news is that 1/3 of children with CM-I, syringomyelia, and scoliosis will improve their scoliosis curve following posterior fossa decompression. Another 14% will stabilize.
The authors also conclude:
Patients presenting with more severe scoliosis (increasing Cobb angle), lack of syrinx improvement during follow-up, or scoliosis crossing the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curve progression after cervicomedullary decompression.
John Oro’, MDChiari Times is not able to respond to specific patient inquiries.
For patient inquiries, please see one of the sites listed
in the
Organizations section.
Copyright © 2007-2008 CyberMed, LLC
The authors reviewed the Johns Hopkins Hospital records from 1995-2005 of children undergoing first-time posterior fossa decompression for CM-I. Of the 258 children identified, 33 children (13%) had CM-I and scoliosis. Children undergoing posterior fossa decompression and concurrent spinal fusion were excluded. Twenty-one children treated by posterior fossa decompression for CM-I were available for review.
Mean age of the children was 9 years (range 6-12 y). Indications for surgery were 5 of more mm of tonsillar herniation (a conservative measure, see abstract on Chiari 0), and either Chiari symptoms or syringomyelia with scoliosis greater than 10 degrees. Posterior fossa craniectomy and C1 laminectomy was performed in all 21 children.
The majority also underwent duraplasty. Duraplasty was not performed in patients with minimal tonsillar ectopia and evidence of physiological hindbrain cerebrospinal fluid flow and tonsillar pulsations on intraoperative ultrasonography after decompression.
Results
The scoliosis curve improved after surgery in 38% of the children and progressed in 48%. The remaining showed no change. Scoliosis was more likely to progress in children with thoracolumbar scoliosis that in those with just thoracic or lumbar scoliosis. It was also more likely to progress if the syrinx did not decrease in size after surgery.
In the only child in this group that did not have a duraplasty, the syrinx did not decrease and the scoliosis progressed.
Conclusions
The good news is that 1/3 of children with CM-I, syringomyelia, and scoliosis will improve their scoliosis curve following posterior fossa decompression. Another 14% will stabilize.
The authors also conclude:
Patients presenting with more severe scoliosis (increasing Cobb angle), lack of syrinx improvement during follow-up, or scoliosis crossing the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curve progression after cervicomedullary decompression.
John Oro’, MD
Chiari Times is not able to respond to specific patient inquiries.
For patient inquiries, please see one of the sites listed
in theOrganizations section.
Copyright © 2007-2008 CyberMed, LLC