Clinical Outcomes of Different Surgical Strategy for Patients With Congenital Scoliosis and Type I Split Cord Malformation.

STUDY
DESIGN: A retrospective study.
OBJECTIVE: To compare the clinical outcomes of different surgical strategy for patients with congenital scoliosis (CS) and type I split cord malformation (SCM). SUMMARY OF BACKGROUND DATA: CS associated with type I SCM is a challenge for spine surgeon because of the high potential rate of neurological compromise. Traditionally, bony spur resection (BR) has been indicated before any procedure for scoliosis correction.
METHODS: From May 2002 to February 2013, 82 CS patients with type I SCM who underwent corrective surgery at our center were retrospectively reviewed. There were 20 male and 62 female patients with an average age of 13.8 years (4-39 yrs) at surgery. They were divided into two groups according to different surgical strategy. The patients in the BR group underwent staged prophylactic neurosurgery or one-stage BR before corrective surgery, whereas patients in the nonresection (NR) group underwent one-stage corrective surgery without addressing bony spur.
RESULTS: There were 15 patients in the BR group and 67 patients in the NR group. No significant differences were detected in preoperative characteristics between two groups. The average follow up was 37 months (24-105 months). In the BR group, the correction rate was 53.0% and 45.9% at the final follow up. Whereas, in the NR group, the correction rate was 48.5% and 42.1% at the final follow up. Compared with the NR group, the operation time and blood loss were statistically higher in the BR group. Five patients experienced transient neurological complications and one patient in the BR group suffered permanent neurological damage of incomplete loss bladder control.
CONCLUSION: One-stage corrective surgery could be safe and effective for patients with CS and SCM. For patients with intact or stable neurological status, prophylactic neurosurgical intervention to remove bony spur before curve correction may not be necessary. LEVEL OF EVIDENCE: 4.