Tags

Type your tag names separated by a space and hit enter

Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction.
J Neurosurg Pediatr. 2018 02; 21(2):185-189.JN

Abstract

OBJECTIVE

Previous reports have addressed the short-term response of patients with Chiari-related scoliosis (CRS) to suboccipital decompression and duraplasty (SODD); however, the long-term behavior of the curve has not been well defined. The authors undertook a longitudinal study of a cohort of patients who underwent SODD for CRS to determine whether there are factors related to Chiari malformation (CM) that predict long-term scoliotic curve behavior and need for deformity correction.

METHODS

The authors retrospectively reviewed cases in which patients underwent SODD for CRS during a 14-year period at a single center. Clinical (age, sex, and associated disorders/syndromes) and radiographic (CM type, tonsillar descent, pBC2 line, clival-axial angle [CXA], syrinx length and level, and initial Cobb angle) information was evaluated to identify associations with the primary outcome: delayed thoracolumbar fusion for progressive scoliosis.

RESULTS

Twenty-eight patients were identified, but 4 were lost to follow-up and 1 underwent fusion within a year. Among the remaining 23 patients, 11 required fusion surgery at an average of 88.3 ± 15.4 months after SODD, including 7 (30%) who needed fusion more than 5 years after SODD. On univariate analysis, a lower CXA (131.5° ± 4.8° vs 146.5° ± 4.6°, p = 0.034), pBC2 > 9 mm (64% vs 25%, p = 0.06), and higher initial Cobb angle (35.1° ± 3.6° vs 22.8° ± 4.0°, p = 0.035) were associated with the need for thoracolumbar fusion. Multivariable modeling revealed that lower CXA was independently associated with a need for delayed thoracolumbar fusion (OR 1.12, p = 0.0128).

CONCLUSIONS

This investigation demonstrates the long-term outcome and natural history of CRS after SODD. The durability of the effect of SODD on CRS and curve behavior is poor, with late curve progression occurring in 30% of patients. Factors associated with CRS progression include an initial pBC2 > 9 mm, lower CXA, and higher Cobb angle. Lower CXA was an independent predictor of delayed thoracolumbar fusion. Further study is necessary on a larger cohort of patients to fully elucidate this relationship.

Authors+Show Affiliations

1Department of Neurosurgery, University of Utah, Primary Children's Hospital.2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; and.3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts.4Department of Orthopedic Surgery, Primary Children's Hospital, Salt Lake City, Utah.4Department of Orthopedic Surgery, Primary Children's Hospital, Salt Lake City, Utah.1Department of Neurosurgery, University of Utah, Primary Children's Hospital.1Department of Neurosurgery, University of Utah, Primary Children's Hospital.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29171800

Citation

Ravindra, Vijay M., et al. "Chiari-related Scoliosis: a Single-center Experience With Long-term Radiographic Follow-up and Relationship to Deformity Correction." Journal of Neurosurgery. Pediatrics, vol. 21, no. 2, 2018, pp. 185-189.
Ravindra VM, Onwuzulike K, Heller RS, et al. Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction. J Neurosurg Pediatr. 2018;21(2):185-189.
Ravindra, V. M., Onwuzulike, K., Heller, R. S., Quigley, R., Smith, J., Dailey, A. T., & Brockmeyer, D. L. (2018). Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction. Journal of Neurosurgery. Pediatrics, 21(2), 185-189. https://doi.org/10.3171/2017.8.PEDS17318
Ravindra VM, et al. Chiari-related Scoliosis: a Single-center Experience With Long-term Radiographic Follow-up and Relationship to Deformity Correction. J Neurosurg Pediatr. 2018;21(2):185-189. PubMed PMID: 29171800.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction. AU - Ravindra,Vijay M, AU - Onwuzulike,Kaine, AU - Heller,Robert S, AU - Quigley,Robert, AU - Smith,John, AU - Dailey,Andrew T, AU - Brockmeyer,Douglas L, Y1 - 2017/11/24/ PY - 2017/11/25/pubmed PY - 2018/7/17/medline PY - 2017/11/25/entrez KW - CCJ = craniocervical junction KW - CM = Chiari malformation KW - CM-I = CM Type I KW - CRS = Chiari-related scoliosis KW - CXA = clival-axial angle KW - Chiari decompression KW - Cobb angle KW - SODD = suboccipital decompression and duraplasty KW - clival-axial angle KW - deformity correction KW - long-term follow-up KW - scoliosis KW - spine KW - suboccipital decompression and duraplasty KW - syringopleural shunt KW - syrinx KW - thoracolumbar fusion SP - 185 EP - 189 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 21 IS - 2 N2 - OBJECTIVE Previous reports have addressed the short-term response of patients with Chiari-related scoliosis (CRS) to suboccipital decompression and duraplasty (SODD); however, the long-term behavior of the curve has not been well defined. The authors undertook a longitudinal study of a cohort of patients who underwent SODD for CRS to determine whether there are factors related to Chiari malformation (CM) that predict long-term scoliotic curve behavior and need for deformity correction. METHODS The authors retrospectively reviewed cases in which patients underwent SODD for CRS during a 14-year period at a single center. Clinical (age, sex, and associated disorders/syndromes) and radiographic (CM type, tonsillar descent, pBC2 line, clival-axial angle [CXA], syrinx length and level, and initial Cobb angle) information was evaluated to identify associations with the primary outcome: delayed thoracolumbar fusion for progressive scoliosis. RESULTS Twenty-eight patients were identified, but 4 were lost to follow-up and 1 underwent fusion within a year. Among the remaining 23 patients, 11 required fusion surgery at an average of 88.3 ± 15.4 months after SODD, including 7 (30%) who needed fusion more than 5 years after SODD. On univariate analysis, a lower CXA (131.5° ± 4.8° vs 146.5° ± 4.6°, p = 0.034), pBC2 > 9 mm (64% vs 25%, p = 0.06), and higher initial Cobb angle (35.1° ± 3.6° vs 22.8° ± 4.0°, p = 0.035) were associated with the need for thoracolumbar fusion. Multivariable modeling revealed that lower CXA was independently associated with a need for delayed thoracolumbar fusion (OR 1.12, p = 0.0128). CONCLUSIONS This investigation demonstrates the long-term outcome and natural history of CRS after SODD. The durability of the effect of SODD on CRS and curve behavior is poor, with late curve progression occurring in 30% of patients. Factors associated with CRS progression include an initial pBC2 > 9 mm, lower CXA, and higher Cobb angle. Lower CXA was an independent predictor of delayed thoracolumbar fusion. Further study is necessary on a larger cohort of patients to fully elucidate this relationship. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/29171800/Chiari_related_scoliosis:_a_single_center_experience_with_long_term_radiographic_follow_up_and_relationship_to_deformity_correction_ L2 - https://thejns.org/doi/10.3171/2017.8.PEDS17318 DB - PRIME DP - Unbound Medicine ER -