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Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients.
World Neurosurg. 2017 Feb; 98:98-103.WN

Abstract

BACKGROUND

Few studies have assessed the effect of Chiari malformation type 1 (CM-1) surgical decompression on cervical lordosis and range of motion (ROM). We aimed to assess the effect of expansile duraplasty on postoperative cervical mobility and spinal stability.

MATERIALS AND METHODS

This was a single-center retrospective review of prospectively collected data. Patients were included if they underwent surgical treatment for symptomatic CM-1 between the years 1999 and 2009. Cervical ROM and lordosis were assessed before and after surgery in all patients. Collected data also included clinical improvement, as well as surgical complications after the procedure. Patients were divided into 2 groups. The first group underwent a posterior fossa bony decompression alone, while the second group additionally received an expansile duraplasty. Patients were further subdivided into 3 subgroups on the basis of the severity of tonsillar herniation.

RESULTS

A total of 76 patients fit our selection criteria. Fifty-five patients belonged to the duraplasty group. Twenty-one patients underwent bony decompression alone. The 2 groups were statistically demographically and clinically similar. There was no difference in clinical outcome or in ROM and cervical lordosis between the groups except for patients with severe tonsillar herniation (CM-I grade 3). These patients had a statistically significant improvement in their postoperative cervical motility without compromising their spinal stability.

CONCLUSION

Adding an expansile duraplasty to craniovertebral decompression in CM-1 patients with severe tonsillar herniation may restore cervical ROM while preserving stability and alignment. This may relieve postoperative pain and improve clinical prognosis.

Authors+Show Affiliations

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: kamran.urgun@utsouthwestern.edu.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27816775

Citation

Yilmaz, Adem, et al. "Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients." World Neurosurgery, vol. 98, 2017, pp. 98-103.
Yilmaz A, Urgun K, Aoun SG, et al. Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients. World Neurosurg. 2017;98:98-103.
Yilmaz, A., Urgun, K., Aoun, S. G., Colak, I., Yilmaz, I., Altas, K., & Musluman, M. (2017). Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients. World Neurosurgery, 98, 98-103. https://doi.org/10.1016/j.wneu.2016.10.127
Yilmaz A, et al. Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients. World Neurosurg. 2017;98:98-103. PubMed PMID: 27816775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients. AU - Yilmaz,Adem, AU - Urgun,Kamran, AU - Aoun,Salah G, AU - Colak,Ibrahim, AU - Yilmaz,Ilhan, AU - Altas,Kadir, AU - Musluman,Murat, Y1 - 2016/11/02/ PY - 2016/09/02/received PY - 2016/10/24/revised PY - 2016/10/25/accepted PY - 2016/11/7/pubmed PY - 2017/9/16/medline PY - 2016/11/7/entrez KW - Cervical lordosis KW - Cervical range of motion KW - Chiari type 1 malformation KW - Expansile duraplasty KW - Surgical outcome SP - 98 EP - 103 JF - World neurosurgery JO - World Neurosurg VL - 98 N2 - BACKGROUND: Few studies have assessed the effect of Chiari malformation type 1 (CM-1) surgical decompression on cervical lordosis and range of motion (ROM). We aimed to assess the effect of expansile duraplasty on postoperative cervical mobility and spinal stability. MATERIALS AND METHODS: This was a single-center retrospective review of prospectively collected data. Patients were included if they underwent surgical treatment for symptomatic CM-1 between the years 1999 and 2009. Cervical ROM and lordosis were assessed before and after surgery in all patients. Collected data also included clinical improvement, as well as surgical complications after the procedure. Patients were divided into 2 groups. The first group underwent a posterior fossa bony decompression alone, while the second group additionally received an expansile duraplasty. Patients were further subdivided into 3 subgroups on the basis of the severity of tonsillar herniation. RESULTS: A total of 76 patients fit our selection criteria. Fifty-five patients belonged to the duraplasty group. Twenty-one patients underwent bony decompression alone. The 2 groups were statistically demographically and clinically similar. There was no difference in clinical outcome or in ROM and cervical lordosis between the groups except for patients with severe tonsillar herniation (CM-I grade 3). These patients had a statistically significant improvement in their postoperative cervical motility without compromising their spinal stability. CONCLUSION: Adding an expansile duraplasty to craniovertebral decompression in CM-1 patients with severe tonsillar herniation may restore cervical ROM while preserving stability and alignment. This may relieve postoperative pain and improve clinical prognosis. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27816775/Adding_Expansile_Duraplasty_to_Posterior_Fossa_Decompression_May_Restore_Cervical_Range_of_Motion_in_Grade_3_Chiari_Malformation_Type_1_Patients_ DB - PRIME DP - Unbound Medicine ER -