Risks and outcomes of spinal deformity surgery in Chiari malformation, Type 1, with syringomyelia versus adolescent idiopathic scoliosis.
Risks and outcomes of spinal deformity surgery in Chiari malformation, Type 1, with syringomyelia versus adolescent idiopathic scoliosis.
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DOI：
10.1016/j.spinee.2015.04.048
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发表时间：
2015-09-01
期刊：
影响因子：
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通讯作者：
Kelly MP
中科院分区：
文献类型：
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作者：
Godzik J;Holekamp TF;Limbrick DD;Lenke LG;Park TS;Ray WZ;Bridwell KH;Kelly MP
Chiari畸形，1型，合并脊髓空洞症(CIM+SM)，常与脊柱畸形相关。脊柱侧弯手术的安全性这一人群是有争议的，并且从未被直接与青少年特发性脊柱侧凸(AIS)进行比较。目的：比较Chiari畸形I型脊柱侧凸患者与匹配的青少年特发性脊柱侧凸患者脊柱畸形手术的安全性和主观结果。回顾性配对队列分析在同一机构的手术记录中确定了CIM+SM并接受脊柱融合术的脊柱畸形患者，并与在同一机构接受脊柱融合术的AIS患者按1：1匹配。神经学监测数据的质量和完整性、放射学参数、脊柱侧弯研究会-22评分。我们回顾了2000-2012年间在我所接受脊柱重建术的CIM+SM相关脊柱畸形患者的临床数据库。36名CIM+SM患者被确定，并根据年龄、性别、主弯大小、融合长度和翻修状态与AIS队列(1：1)匹配。记录至少2年的人口统计学、畸形形态、手术细节、神经监测数据以及手术前后的SRS-22评分。比较两组内和组间SRS-22评分的变化。比较两组间的并发症和神经监测数据问题。平均年龄14.5±5岁(CIM+SM：14.6±5；AIS：14.4±5)，男性占42%。平均后凸角度52°±17对41°±20(p=0.018)。平均融合椎体(10.4±2.8vs.10.4±2.3vs.10.4±2.6p=0.928)。在手术方式(p=0.336)、估计出血量(680ml±720vs.660±310vs.660±310vs.660±310，p=0.845)和手术时间(6.0h±2.2vs.5.6±2，p=0.434)方面没有差异。两组的并发症发生率相似(33%比14%，p=0.052)。CIM+SM组的神经系统并发症(11%比0%，p=0.04)和神经监测困难(28%比3%，p=0.007)明显多于AIS组。平均曲线校正在2年时相似(58%CIM+SM vs.%AIS，p=0.2)。在随访时，CIM+SM组和AIS组的累积SRS-22结果亚分均有改善(CIM+SM：+0.40，p=0.027；AIS：+0.3，p<；0.001)。CIM+SM组和AIS组之间的预后亚分没有差异。虽然接受脊柱重建的CIM+SM患者可以预期与AIS患者相似的畸形矫正和结果评分，但他们也经历了更高的神经监测困难和与手术相关的神经并发症。外科医生应该为这些困难做好准备，特别是对于有较大空洞的儿童。
Chiari Malformation, Type 1, with syringomyelia (CIM+SM) is often associated with spinal deformity. The safety of scoliosis surgery this population is controversial, and has never been directly compared with adolescent idiopathic scoliosis (AIS). Purpose: Compare the safety and subjective outcomes of spinal deformity surgery between patients with Chiari Malformation I associated scoliosis and a matched Adolescent Idiopathic Scoliosis cohort. Retrospective matched cohort analysis Patients with CIM+SM and treated with spinal fusion for spinal deformity were identified in the surgical records of a single institution and were matched, 1:1, with AIS patients undergoing spinal fusion at the same institution. Neurological monitoring data quality and integrity, radiographic parameters, Scoliosis Research Society-22 Scores. A clinical database was reviewed for patients undergoing spinal reconstruction for CIM+SM associated spinal deformity at our institution from 2000 to 2012. Thirty-six CIM+SM patients were identified and matched to an AIS cohort (1:1) based on age, gender, major curve magnitude, fusion length, and revision status. Demographics, deformity morphology, surgical details, neuromonitoring data, and pre- and postoperative SRS-22 scores were recorded at a minimum 2-year followup. Changes in SRS-22 scores were compared within and between groups. Complications and neurological monitoring data issues were compared between groups. Mean age was 14.5±5 years (CIM+SM: 14.6±5; AIS: 14.4±5), and 42% of patients were male. Preoperative mean major coronal Cobb measured 58°±25 vs. 57°±17 (p=0.84) with mean kyphosis 52°±17 vs. 41°±20 (p=0.018). An average of 10.4±2.6 vertebral levels were fused (10.4±2.8 vs. 10.4±2.3, p=0.928). No differences existed in surgical approach (p=0.336), estimated blood loss (680mL±720 vs. 660±310, p=0.845), or duration of surgery (6.0 hours ±2.2 vs. 5.6 ± 2, p=0.434). Complication rate was comparable between the two groups (33% vs. 14%, p=0.052). CIM+SM experienced more neurological complications (11% vs. 0%, p=0.04) and neuromonitoring difficulties (28% vs. 3%, p=0.007) than the AIS cohort. Mean curve correction was comparable at 2 years (58% CIM+SM vs. 64% AIS, p=0.2). At follow-up, both CIM+SM and AIS groups demonstrated improved cumulative SRS-22 outcome subscores (CIM+SM: +0.4, p=0.027; AIS: +0.3, p<0.001). No difference in outcome subscores existed between CIM+SM and AIS groups. While CIM+SM patients undergoing spine reconstruction can expect similar deformity corrections and outcomes scores to AIS patients, they also experience higher rates of neuromonitoring difficulties and neurological complications related to surgery. Surgeons should be prepared for these difficulties, particularly in children with larger syrinx size.