Nora P O'Neill1, Patricia E Miller1, Michael T Hresko1,2, John B Emans1,2, Lawrence I Karlin1,2, Daniel J Hedequist1,2, Brian D Snyder1,2, Edward R Smith3,2, Mark R Proctor3,2, Michael P Glotzbecker4,5,6. 1. Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA. 4. Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA. michael.glotzbecker@UHhospitals.org. 5. Harvard Medical School, Boston, MA, USA. michael.glotzbecker@UHhospitals.org. 6. Pediatric Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA. michael.glotzbecker@UHhospitals.org.
Abstract
PURPOSE: Many patients with presumed idiopathic scoliosis are found to have Chiari I malformation (CM-I) on MRI. The objective of this study is to report on scoliosis progression in CM-I with no syringomyelia. METHODS: A retrospective review of patients with scoliosis and CM-I was conducted from 1997 to 2015. Patients with syringomyelia and/or non-idiopathic scoliosis were excluded. Clinical and radiographic characteristics were recorded at presentation and latest follow-up. CM-I was defined as the cerebellar tonsil extending 5 mm or more below the foramen magnum on MRI. RESULTS: Thirty-two patients (72% female) with a mean age of 11 years (range 1-16) at scoliosis diagnosis were included. The average initial curve was 30.3° ± SD 16.3. The mean initial Chiari size was 9.6 mm SD ± 4.0. Fifteen (46.9%) experienced Chiari-related symptoms, and three (9%) patients underwent Posterior Fossa Decompression (PFD) to treat these symptoms. 10 (31%) patients went on to fusion, progressing on average 13.6° (95% CI 1.6-25.6°). No association was detected between decompression and either curve progression or fusion (p = 0.46, 0.60). For those who did not undergo fusion, curve magnitude progressed on average 1.0° (95% CI - 4.0 to 5.9°). There was no association between age, Chiari size, presence of symptoms, initial curve shape, or bracing treatment and fusion. CONCLUSION: Patients with CM-I and scoliosis may not require surgical treatment, including PFD and fusion. Scoliosis curvature stabilized in the non-surgical population at an average progression of 1.0°. These results suggest that CM-I with no syringomyelia has minimal effect on scoliosis progression.
PURPOSE: Many patients with presumed idiopathic scoliosis are found to have Chiari I malformation (CM-I) on MRI. The objective of this study is to report on scoliosis progression in CM-I with no syringomyelia. METHODS: A retrospective review of patients with scoliosis and CM-I was conducted from 1997 to 2015. Patients with syringomyelia and/or non-idiopathic scoliosis were excluded. Clinical and radiographic characteristics were recorded at presentation and latest follow-up. CM-I was defined as the cerebellar tonsil extending 5 mm or more below the foramen magnum on MRI. RESULTS: Thirty-two patients (72% female) with a mean age of 11 years (range 1-16) at scoliosis diagnosis were included. The average initial curve was 30.3° ± SD 16.3. The mean initial Chiari size was 9.6 mm SD ± 4.0. Fifteen (46.9%) experienced Chiari-related symptoms, and three (9%) patients underwent Posterior Fossa Decompression (PFD) to treat these symptoms. 10 (31%) patients went on to fusion, progressing on average 13.6° (95% CI 1.6-25.6°). No association was detected between decompression and either curve progression or fusion (p = 0.46, 0.60). For those who did not undergo fusion, curve magnitude progressed on average 1.0° (95% CI - 4.0 to 5.9°). There was no association between age, Chiari size, presence of symptoms, initial curve shape, or bracing treatment and fusion. CONCLUSION:Patients with CM-I and scoliosis may not require surgical treatment, including PFD and fusion. Scoliosis curvature stabilized in the non-surgical population at an average progression of 1.0°. These results suggest that CM-I with no syringomyelia has minimal effect on scoliosis progression.
Authors: Jennifer Strahle; Brandon W Smith; Melaine Martinez; J Rajiv Bapuraj; Karin M Muraszko; Hugh J L Garton; Cormac O Maher Journal: J Neurosurg Pediatr Date: 2015-03-13 Impact factor: 2.375
Authors: Brandon W Smith; Jennifer Strahle; J Rajiv Bapuraj; Karin M Muraszko; Hugh J L Garton; Cormac O Maher Journal: J Neurosurg Date: 2013-06-14 Impact factor: 5.115