Adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia: a retrospective study of correction and fusion strategies.
METHODS
Retrospective case series.


OBJECTIVE
To study the correction and fusion strategies for adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia by using posterior pedicle screw instrumentation (PPSI). Surgical intervention for Chiari malformation and syringomyelia before surgical correction of scoliosis has been reported; however, there are no clinical trials for the PPSI-based correction and fusion procedures used in these patients.


METHODS
From 2002 to 2009, 13 adult patients (mean age, 34.9 years) suffering from thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia underwent correction and fusion by using PPSI. Preoperative, postoperative, and final follow-up coronary Cobb angle, correction rate, pelvic obliquity (PO), apical vertebral rotation (AVR), apical vertebral translation (AVT), trunk shift (TS), sagittal thoracic kyphosis angle, and lumbar lordosis angle were analyzed on radiographs.


RESULTS
The preoperative and postoperative mean coronary Cobb angle was from 46.8° to 9.2°, correction rate was 80.7%, PO from 9.9° to 3.2°, AVR from 1.9° to 0.3°, AVT from 3.6 to 0.8 cm, TS from 16.8 to 1.6 cm, sagittal thoracic kyphosis angle from 18.2° to 23.5°, and lumbar lordosis angle was from 37.4° to 41.8°. The mean follow-up period was 35.2 months (range, 24-50 months). There were no obvious pseudoarticulations or loss of correction and trunk equilibrium at the final follow-up; no aggravation of the original neural symptoms or new irreversible neural injury was observed.


CONCLUSIONS
In patients with mild or moderate adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia, the correction and fusion by using PPSI can yield a satisfactory clinical effect.
Zhang
Hong-Qi
HQ
Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, ChangSha 410008, China. zhq9996@163.com
Deng
Ang
A
Liu
Shao-Hua
SH
Chen
Ling-Qiang
LQ
Guo
Chao-Feng
CF
Tang
Ming-Xing
MX
Wu
Jian-Huang
JH
Liu
Jin-Yang
JY
Chen
Jing
J
D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013595:Syringomyelia / Q000150:complications*; D055815:Young Adult