Tags

Type your tag names separated by a space and hit enter

Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium.
J Neurosurg Pediatr. 2021 Jun 18 [Online ahead of print]JN

Abstract

OBJECTIVE

Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression.

METHODS

A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty.

RESULTS

In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion.

CONCLUSIONS

In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.

Authors+Show Affiliations

1Department of Pediatrics, Washington University in St. Louis, MO.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.17Department of Neurosurgery, Columbia University, New York, NY.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN.5Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.6Department of Neurological Surgery, University of Wisconsin at Madison, WI.7Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR.8Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FL.9Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, IL.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.10Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR.11Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.12Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OH.43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN.13Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT.14Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta, GA.15Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.16Department of Neurosurgery, Mayo Clinic, Rochester, MN.39Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA.18Department of Neurosurgery, University of Vermont, Burlington, VT.19Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, WA.20Department of Neurosurgery, Medical University of South Carolina, Charleston, SC.21Department of Neurosurgery, Duke University, Durham, NC.22Division of Pediatric Neurosurgery, Dell Children's Medical Center, Austin, TX.23Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital and Stanford University School of Medicine, Palo Alto, CA.24Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, MN.25Division of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.26Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.27Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK.28Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN.29Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO.30Division of Pediatric Neurosurgery, Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.31Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.6Department of Neurological Surgery, University of Wisconsin at Madison, WI.32Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN.33Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL.34Department of Neurosurgery, Children's National Medical Center, Washington, DC.36Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TN.37Department of Neurosurgery, Children's Hospital Los Angeles, CA.38Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH.3Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, MI.12Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OH.27Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK.37Department of Neurosurgery, Children's Hospital Los Angeles, CA.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.39Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA.36Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TN.33Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL.40Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL.29Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO.41Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL.10Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR.42Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TX.43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN. 47Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN.4Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.44Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, MA.45Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, FL.46Carolina Neurosurgery & Spine Associates, Charlotte, NC; and.43Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN. 47Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University, Nashville, TN.11Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX.2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.1Department of Pediatrics, Washington University in St. Louis, MO. 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.1Department of Pediatrics, Washington University in St. Louis, MO. 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO. 35Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34144521

Citation

Sadler, Brooke, et al. "Extradural Decompression Versus Duraplasty in Chiari Malformation Type I With Syrinx: Outcomes On Scoliosis From the Park-Reeves Syringomyelia Research Consortium." Journal of Neurosurgery. Pediatrics, 2021, pp. 1-9.
Sadler B, Skidmore A, Gewirtz J, et al. Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr. 2021.
Sadler, B., Skidmore, A., Gewirtz, J., Anderson, R. C. E., Haller, G., Ackerman, L. L., Adelson, P. D., Ahmed, R., Albert, G. W., Aldana, P. R., Alden, T. D., Averill, C., Baird, L. C., Bauer, D. F., Bethel-Anderson, T., Bierbrauer, K. S., Bonfield, C. M., Brockmeyer, D. L., Chern, J. J., ... Strahle, J. M. (2021). Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium. Journal of Neurosurgery. Pediatrics, 1-9. https://doi.org/10.3171/2020.12.PEDS20552
Sadler B, et al. Extradural Decompression Versus Duraplasty in Chiari Malformation Type I With Syrinx: Outcomes On Scoliosis From the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr. 2021 Jun 18;1-9. PubMed PMID: 34144521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium. AU - Sadler,Brooke, AU - Skidmore,Alex, AU - Gewirtz,Jordan, AU - Anderson,Richard C E, AU - Haller,Gabe, AU - Ackerman,Laurie L, AU - Adelson,P David, AU - Ahmed,Raheel, AU - Albert,Gregory W, AU - Aldana,Philipp R, AU - Alden,Tord D, AU - Averill,Christine, AU - Baird,Lissa C, AU - Bauer,David F, AU - Bethel-Anderson,Tammy, AU - Bierbrauer,Karin S, AU - Bonfield,Christopher M, AU - Brockmeyer,Douglas L, AU - Chern,Joshua J, AU - Couture,Daniel E, AU - Daniels,David J, AU - Dlouhy,Brian J, AU - Durham,Susan R, AU - Ellenbogen,Richard G, AU - Eskandari,Ramin, AU - Fuchs,Herbert E, AU - George,Timothy M, AU - Grant,Gerald A, AU - Graupman,Patrick C, AU - Greene,Stephanie, AU - Greenfield,Jeffrey P, AU - Gross,Naina L, AU - Guillaume,Daniel J, AU - Hankinson,Todd C, AU - Heuer,Gregory G, AU - Iantosca,Mark, AU - Iskandar,Bermans J, AU - Jackson,Eric M, AU - Jea,Andrew H, AU - Johnston,James M, AU - Keating,Robert F, AU - Khan,Nickalus, AU - Krieger,Mark D, AU - Leonard,Jeffrey R, AU - Maher,Cormac O, AU - Mangano,Francesco T, AU - Mapstone,Timothy B, AU - McComb,J Gordon, AU - McEvoy,Sean D, AU - Meehan,Thanda, AU - Menezes,Arnold H, AU - Muhlbauer,Michael, AU - Oakes,W Jerry, AU - Olavarria,Greg, AU - O'Neill,Brent R, AU - Ragheb,John, AU - Selden,Nathan R, AU - Shah,Manish N, AU - Shannon,Chevis N, AU - Smith,Jodi, AU - Smyth,Matthew D, AU - Stone,Scellig S D, AU - Tuite,Gerald F, AU - Wait,Scott D, AU - Wellons,John C, AU - Whitehead,William E, AU - Park,Tae Sung, AU - Limbrick,David D, AU - Strahle,Jennifer M, Y1 - 2021/06/18/ PY - 2020/07/22/received PY - 2020/12/03/accepted PY - 2021/6/18/entrez PY - 2021/6/19/pubmed PY - 2021/6/19/medline KW - Chiari I malformation KW - posterior fossa decompression KW - scoliosis KW - spine KW - syringomyelia SP - 1 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr N2 - OBJECTIVE: Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS: A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS: In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS: In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/34144521/Extradural_decompression_versus_duraplasty_in_Chiari_malformation_type_I_with_syrinx:_outcomes_on_scoliosis_from_the_Park_Reeves_Syringomyelia_Research_Consortium_ DB - PRIME DP - Unbound Medicine ER -