The outcomes of scoliosis surgery in patients with syringomyelia
The outcomes of scoliosis surgery in patients with syringomyelia
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DOI：
10.1097/brs.0b013e3181557989
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发表时间：
2007-10-01
期刊：
影响因子：
3
通讯作者：
Barnes, Michael J.
中科院分区：
文献类型：
--
作者：
Bradley, Lyndon J.;Ratahi, Erin D.;Barnes, Michael J.
研究设计.一个连续病例系列的回顾性审查。描述患者的人口统计学资料、空洞形态、畸形特征以及术后矫正、进展和并发症。关于脊髓灰质炎相关脊柱畸形患者的自然史和术后史，有明确的数据可供参考。这是文献中关于这些患者手术结果的最大系列。我们对所有在我们机构接受脊柱畸形治疗并伴有脊髓空洞的患者进行了回顾。对患者的人口统计学、畸形形态、治疗方法和术后结果进行测量和记录。13例患者符合入选标准。所有患者均为Lenke胸廓修正值正常或阳性。10例患者接受神经外科减压。神经外科治疗后，所有曲线均发生进展或保持不变。平均胸椎后凸46度（29度-69度）。与青少年特发性患者人群相比，胸椎后凸显著增加（P = 0.00002）。脊柱侧凸手术前冠状面平均弯曲度为71度（31度-119度），矢状面平均弯曲度为46度（29度-68度）。初次脊柱侧凸手术的平均矫正率为48%（6%-83%）。所有患者在手术过程中进行脊髓监测或唤醒试验。没有手术导致脊髓损伤的病例。3名患者在前路融合后病情明显进展，其中2名患者需要进一步的矫正手术。关节融合术后，随访期间4例患者进展> 10度。特发性胸椎后凸缺乏是潜在的脊髓空洞症的一个强有力的指示。神经外科治疗空洞并没有改善脊柱侧凸。选择融合节段时应谨慎，关节融合术的计划应考虑到潜在的病理学。脊柱侧凸手术已被证明是安全的，在病人治疗空洞时，脊髓监测或唤醒测试使用。
Study Design. A retrospective review of a consecutive case series.Objective. To describe patient demographics, syrinx morphology, and deformity characteristics, as well as postsurgical correction, progression, and complications.Summary of Background Data. Conflicting data are available on the natural and postsurgical history of patients with spinal deformity associated with syringomyelia. This is the largest series in the literature on the surgical outcomes of these patients.Methods. All patients treated for spinal deformity at our institution with an associated syrinx were reviewed. Demographics, deformity morphology, treatment methods, and postoperative outcomes were measured and recorded.Results. Thirteen patients met inclusion criteria. All were Lenke thoracic modifier normal or positive. Ten patients underwent neurosurgical decompression. All curves either progressed or remained unchanged following neurosurgical treatment. The average thoracic kyphosis measured 46 degrees (29 degrees-69 degrees). Thoracic kyphosis was significantly increased compared with a population of adolescent idiopathic patients ( P = 0.00002). The average curve before scoliosis surgery was 71 degrees (31 degrees-119 degrees) in the coronal plane and 46 degrees (29 degrees-68 degrees) in the sagittal plane. The average correction from the initial scoliosis surgery was 48% (6%-83%). All patients had spinal cord monitoring or wake-up tests during surgery. There were no instances of spinal cord injury from surgery. Three patients progressed significantly following anterior fusion, 2 of whom required further corrective surgery. Following arthrodesis, 4 patients progressed > 10 degrees during follow-up.Conclusion. The lack of thoracic hypokyphosis seen in idiopathic-like curves is a strong indicator of a possible underlying syrinx. Neurosurgical treatment of the syrinx did not improve the scoliosis. Caution should be exercised when choosing fusion levels, and arthrodesis should be planned with the underlying pathology in mind. Scoliosis surgery has proven to be safe in patients with treated syrinx when spinal cord monitoring or wake-up tests are used.