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One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?
Eur Spine J. 2011 Jul; 20(7):1106-13.ES

Abstract

Priority of neurological decompression was regarded as necessary for scoliosis patients associated with Chiari I malformation in order to decrease the risk of spinal cord injury from scoliosis surgery. We report a retrospective series of scoliosis associated with Chiari I malformation in 13 adolescent patients and explore the effectiveness and safety of posterior scoliosis correction without suboccipital decompression. One-stage posterior approach total vertebral column resection was performed in seven patients with scoliosis or kyphosis curve >90° (average 100.1° scoliotic and 97.1° kyphotic curves) or presented with apparent neurological deficits, whereas the other six patients underwent posterior pedicle screw instrumentation for correction of spinal deformity alone (average 77.3° scoliotic and 44.0° kyphotic curves). The apex of the scoliosis curve was located at T7-T12. Mean operating time and intraoperative hemorrhage was 463 min and 5,190 ml in patients undergoing total vertebral column resection, with average correction rate of scoliosis and kyphosis being 63.3 and 71.1%, respectively. Mean operating time and intraoperative hemorrhage in patients undergoing instrumentation alone was 246 min and 1,450 ml, with the average correction rate of scoliosis and kyphosis being 60.8 and 53.4%, respectively. The mean follow-up duration was 32.2 months. No iatrogenic neurological deterioration had been encountered during the operation procedure and follow-up. After vertebral column resection, neurological dysfunctions such as relaxation of anal sphincter or hypermyotonia that occurred in three patients preoperatively improved gradually. In summary, suboccipital decompression prior to correction of spine deformity may not always be necessary for adolescent patients with scoliosis associated with Chiari I malformation. Particularly in patients with a severe and rigid curve or with significant neurological deficits, posterior approach total vertebral column resection is likely a good option, which could not only result in satisfactory correction of deformity, but also decrease the risk of neurological injury secondary to surgical intervention by shortening spine and reducing the tension of spinal cord.

Authors+Show Affiliations

Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, No.112 Kunrui Road, Kunming 650101, Yunnan, People's Republic of China. xiejingming@vip.163.comNo 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

21399931

Citation

Xie, Jingming, et al. "One-stage and Posterior Approach for Correction of Moderate to Severe Scoliosis in Adolescents Associated With Chiari I Malformation: Is a Prior Suboccipital Decompression Always Necessary?" European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 20, no. 7, 2011, pp. 1106-13.
Xie J, Wang Y, Zhao Z, et al. One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? Eur Spine J. 2011;20(7):1106-13.
Xie, J., Wang, Y., Zhao, Z., Zhang, Y., Si, Y., Yang, Z., Liu, L., & Lu, N. (2011). One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(7), 1106-13. https://doi.org/10.1007/s00586-011-1717-6
Xie J, et al. One-stage and Posterior Approach for Correction of Moderate to Severe Scoliosis in Adolescents Associated With Chiari I Malformation: Is a Prior Suboccipital Decompression Always Necessary. Eur Spine J. 2011;20(7):1106-13. PubMed PMID: 21399931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? AU - Xie,Jingming, AU - Wang,Yingsong, AU - Zhao,Zhi, AU - Zhang,Ying, AU - Si,Yongyu, AU - Yang,Zhendong, AU - Liu,Luping, AU - Lu,Ning, Y1 - 2011/03/12/ PY - 2009/11/12/received PY - 2011/02/06/accepted PY - 2011/01/24/revised PY - 2011/3/15/entrez PY - 2011/3/15/pubmed PY - 2012/2/10/medline SP - 1106 EP - 13 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 20 IS - 7 N2 - Priority of neurological decompression was regarded as necessary for scoliosis patients associated with Chiari I malformation in order to decrease the risk of spinal cord injury from scoliosis surgery. We report a retrospective series of scoliosis associated with Chiari I malformation in 13 adolescent patients and explore the effectiveness and safety of posterior scoliosis correction without suboccipital decompression. One-stage posterior approach total vertebral column resection was performed in seven patients with scoliosis or kyphosis curve >90° (average 100.1° scoliotic and 97.1° kyphotic curves) or presented with apparent neurological deficits, whereas the other six patients underwent posterior pedicle screw instrumentation for correction of spinal deformity alone (average 77.3° scoliotic and 44.0° kyphotic curves). The apex of the scoliosis curve was located at T7-T12. Mean operating time and intraoperative hemorrhage was 463 min and 5,190 ml in patients undergoing total vertebral column resection, with average correction rate of scoliosis and kyphosis being 63.3 and 71.1%, respectively. Mean operating time and intraoperative hemorrhage in patients undergoing instrumentation alone was 246 min and 1,450 ml, with the average correction rate of scoliosis and kyphosis being 60.8 and 53.4%, respectively. The mean follow-up duration was 32.2 months. No iatrogenic neurological deterioration had been encountered during the operation procedure and follow-up. After vertebral column resection, neurological dysfunctions such as relaxation of anal sphincter or hypermyotonia that occurred in three patients preoperatively improved gradually. In summary, suboccipital decompression prior to correction of spine deformity may not always be necessary for adolescent patients with scoliosis associated with Chiari I malformation. Particularly in patients with a severe and rigid curve or with significant neurological deficits, posterior approach total vertebral column resection is likely a good option, which could not only result in satisfactory correction of deformity, but also decrease the risk of neurological injury secondary to surgical intervention by shortening spine and reducing the tension of spinal cord. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/21399931/One_stage_and_posterior_approach_for_correction_of_moderate_to_severe_scoliosis_in_adolescents_associated_with_Chiari_I_malformation:_is_a_prior_suboccipital_decompression_always_necessary L2 - https://doi.org/10.1007/s00586-011-1717-6 DB - PRIME DP - Unbound Medicine ER -