Scoliosis associated with Chiari I malformations: The effect of suboccipital decompression on scoliosis curve progression - A preliminary study
Scoliosis associated with Chiari I malformations: The effect of suboccipital decompression on scoliosis curve progression - A preliminary study
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DOI：
10.1097/01.brs.0000092381.05229.87
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发表时间：
2003-11-15
期刊：
影响因子：
3
通讯作者：
Smith, JT
中科院分区：
文献类型：
--
作者：
Brockmeyer, D;Gollogly, S;Smith, JT
研究设计.回顾性分析了枕下减压和硬脑膜成形术对22例患有脊柱侧凸、脊髓压迫症和基亚里1畸形的患者弯曲进展的影响。记录与基亚里1畸形相关的脊柱侧凸的临床特征，确定枕下减压和硬脑膜成形术对脊柱侧凸曲线随时间进展的影响，并确定可能与枕下减压后脊柱侧凸畸形临床改善相关的临床因素（年龄、性别和曲线特征）。之前的出版物记录了基亚里1畸形的临床特征、体征和症状。基亚里1畸形、脊髓灰质炎和脊柱侧凸之间的关联已被认识和报道。几位作者也报道了脊柱侧凸对基亚里1减压的反应，但这些报道中的患者数量很少。该队列代表了迄今为止最大数量的（21例）患有基亚里1畸形、脊髓灰质炎和脊柱侧凸的患者，这些患者接受了治疗并随时间随访，以确定减压对弯曲进展的影响。对1990年至2000年11月期间因基亚里1畸形接受后颅窝减压术的85例16岁或16岁以下患者进行回顾性病例分析。从这个较大的队列中选择最初表现为脊柱侧凸，然后发现有基亚里1畸形的7名男性和15名女性（共85名患者中的22名）的亚组进行进一步审查。然后对这些患者的骨科和神经外科图表、脊柱X线片和磁共振成像扫描进行回顾。22名患有脊柱侧弯的患者中，有21名符合入选标准，即在枕下减压后的随访期间存在基亚里1级畸形、脊柱侧弯和脊柱未融合。1例患者在枕下减压前接受了后路脊柱融合术，因此被排除在进一步审查之外。21例研究患者中有13例（62%）在随访期间曲线改善或稳定。21例患者中有8例（38%）出现曲线进展。进一步的分析表明，年龄、性别和脊柱侧凸的初始大小影响枕下减压对脊柱侧凸行为的影响。具体而言，11例患者中有10例（91%）在枕下减压时年龄小于10岁，在随访期间其曲线改善或保持不变。相比之下，7例年龄大于10岁的女性患者中有5例（72%）在枕下减压前弯曲大于40度，已经融合或正在等待融合。
Study Design. A retrospective review of the effect of suboccipital decompression and duraplasty on curve progression in 22 patients who presented with scoliosis, syringomyelia, and a Chiari 1 malformation.Objectives. To document the clinical characteristics of scoliosis in association with a Chiari 1 malformation, determine the effects of suboccipital decompression and duraplasty on scoliosis curve progression over time, and identify the clinical factors ( age, gender, and curve characteristics) that may be associated with a clinical improvement in the scoliotic deformity after suboccipital decompression.Summary of Background Data. Prior publications have documented the clinical characteristics, signs, and symptoms of the Chiari 1 malformation. An association between Chiari 1 malformations, syringomyelia, and scoliosis has been recognized and reported. Several authors have also reported on the response of the scoliotic curve to Chiari 1 decompression, but the number of patients in these reports has been small. This cohort represents the largest number of patients to date ( 21) with Chiari 1 malformations, syringomyelia, and scoliosis who have been treated and followed over time in order to determine the effect of decompression on curve progression.Methods. A retrospective case review of 85 patients, age 16 years or less, who underwent posterior fossa decompression for a Chiari 1 malformation between 1990 and November 2000. A subset of 7 males and 15 females ( 22 of 85 total patients) who initially presented with scoliosis and were then found to have a Chiari 1 malformation was selected from this larger cohort for further review. The orthopedic and neurosurgical charts, spinal radiographs, and magnetic resonance imaging scans were then reviewed for each of these patients.Results. Twenty- one of the 22 patients who presented with scoliosis met the inclusion criteria of having a Chiari 1 malformation, scoliosis, and an unfused spine during the follow- up period after suboccipital decompression. One patient had a posterior spinal fusion before suboccipital decompression and was excluded from further review.Conclusions. Thirteen patients of the 21 study patients ( 62%) had curve improvement or stabilization during the follow- up period. Eight of 21 patients ( 38%) had curve progression. Closer analysis reveals that the age, gender, and initial size of the scoliotic curve influenced the results of suboccipital decompression on the behavior of the scoliosis. Specifically, 10 of 11 patients ( 91%) who were less than 10 years of age at the time of suboccipital decompression have had their curves improve or stay the same during follow- up. In contrast, 5 of 7 female patients ( 72%) older than 10 years old with a curve greater than 40degrees before suboccipital decompression have either been fused or are awaiting fusion.