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Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression.
J Neurosurg Pediatr. 2008 Jun; 1(6):456-60.JN

Abstract

OBJECT

Chiari malformation Type I (CM-I) is often associated with scoliosis. It remains unclear which subgroups of patients are most likely to experience progression of spinal deformity after cervicomedullary decompression. The authors' goal was to determine the time frame of curvature progression and assess which patient subgroups are at greatest risk for progression of spinal deformity after surgery.

METHODS

The authors retrospectively reviewed the records of all pediatric patients with significant scoliosis in whom suboccipital decompression was performed to treat for CM-I during a 10-year period at a single academic institution. Clinical, radiological, and operative variables were assessed as independent factors for failure (worsening of scoliosis) by using a univariate regression analysis.

RESULTS

Twenty-one children (mean age 9 +/- 3 years; 4 male) underwent hindbrain decompression for CM-I-associated scoliosis and were followed for a mean of 39 months. All patients harbored a syrinx. Eight patients (38%) experienced improvement in scoliosis curvature, whereas 10 (48%) suffered a progression. Thoracolumbar junction scoliosis (p = 0.04) and failure of the syrinx to improve (p = 0.05) were associated with 5- and 4-fold respective increases in the likelihood of deformity progression. Each increasing degree of preoperative Cobb angle was associated with an 11% increase in the likelihood of scoliotic curve progression (p < 0.05).

CONCLUSIONS

Over one third of patients with CM-I-associated scoliosis will improve after cervicomedullary decompression alone. Cervicomedullary decompression is a good first-line option, particularly in children with concordant posterior fossa symptoms. Patients presenting with more severe scoliosis (increasing Cobb angle) or scoliosis that crosses the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curvature progression after cervicomedullary decompression. In cases in which there is a failure of the syrinx to show improvement after suboccipital decompression, the patients are also more likely to develop curvature progression.

Authors+Show Affiliations

Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21218, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18518696

Citation

Attenello, Frank J., et al. "Suboccipital Decompression for Chiari Malformation-associated Scoliosis: Risk Factors and Time Course of Deformity Progression." Journal of Neurosurgery. Pediatrics, vol. 1, no. 6, 2008, pp. 456-60.
Attenello FJ, McGirt MJ, Atiba A, et al. Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression. J Neurosurg Pediatr. 2008;1(6):456-60.
Attenello, F. J., McGirt, M. J., Atiba, A., Gathinji, M., Datoo, G., Weingart, J., Carson, B., & Jallo, G. I. (2008). Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression. Journal of Neurosurgery. Pediatrics, 1(6), 456-60. https://doi.org/10.3171/PED/2008/1/6/456
Attenello FJ, et al. Suboccipital Decompression for Chiari Malformation-associated Scoliosis: Risk Factors and Time Course of Deformity Progression. J Neurosurg Pediatr. 2008;1(6):456-60. PubMed PMID: 18518696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression. AU - Attenello,Frank J, AU - McGirt,Matthew J, AU - Atiba,April, AU - Gathinji,Muraya, AU - Datoo,Ghazala, AU - Weingart,Jon, AU - Carson,Benjamin, AU - Jallo,George I, PY - 2008/6/4/pubmed PY - 2008/7/11/medline PY - 2008/6/4/entrez SP - 456 EP - 60 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 1 IS - 6 N2 - OBJECT: Chiari malformation Type I (CM-I) is often associated with scoliosis. It remains unclear which subgroups of patients are most likely to experience progression of spinal deformity after cervicomedullary decompression. The authors' goal was to determine the time frame of curvature progression and assess which patient subgroups are at greatest risk for progression of spinal deformity after surgery. METHODS: The authors retrospectively reviewed the records of all pediatric patients with significant scoliosis in whom suboccipital decompression was performed to treat for CM-I during a 10-year period at a single academic institution. Clinical, radiological, and operative variables were assessed as independent factors for failure (worsening of scoliosis) by using a univariate regression analysis. RESULTS: Twenty-one children (mean age 9 +/- 3 years; 4 male) underwent hindbrain decompression for CM-I-associated scoliosis and were followed for a mean of 39 months. All patients harbored a syrinx. Eight patients (38%) experienced improvement in scoliosis curvature, whereas 10 (48%) suffered a progression. Thoracolumbar junction scoliosis (p = 0.04) and failure of the syrinx to improve (p = 0.05) were associated with 5- and 4-fold respective increases in the likelihood of deformity progression. Each increasing degree of preoperative Cobb angle was associated with an 11% increase in the likelihood of scoliotic curve progression (p < 0.05). CONCLUSIONS: Over one third of patients with CM-I-associated scoliosis will improve after cervicomedullary decompression alone. Cervicomedullary decompression is a good first-line option, particularly in children with concordant posterior fossa symptoms. Patients presenting with more severe scoliosis (increasing Cobb angle) or scoliosis that crosses the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curvature progression after cervicomedullary decompression. In cases in which there is a failure of the syrinx to show improvement after suboccipital decompression, the patients are also more likely to develop curvature progression. SN - 1933-0707 UR - https://www.unboundmedicine.com/medline/citation/18518696/Suboccipital_decompression_for_Chiari_malformation_associated_scoliosis:_risk_factors_and_time_course_of_deformity_progression_ L2 - https://thejns.org/doi/10.3171/PED/2008/1/6/456 DB - PRIME DP - Unbound Medicine ER -