Safety and efficacy of 1-stage surgical treatment of congenital spinal deformity associated with split spinal cord malformation.
METHODS
Retrospective clinical study.


OBJECTIVE
The aim of this study was to evaluate retrospectively the safety and efficacy of 1-stage surgical treatment of 45 consecutive patients, who had progressive congenital spinal deformity associated with split spinal cord malformation (SSCM).


BACKGROUND
For correction of progressive congenital spinal deformity with SSCM, it has been reported that all SSCM should be operated on before any orthopedic intervention, and then surgery for correction and stabilization of the spinal deformity should be performed 3 to 6 months later. Recently, different viewpoints have been approved, and the common treatment of these 2 associated conditions needs to be re-evaluated.


METHODS
Patients had 1-stage surgery. After exposure of the determined levels and placement of instruments, bony spur was resected in the patients of type 1; in patients of type 2, we did nothing to the SSCM. In the corrective stage of surgery, posterior fusion surgery was performed in 38 patients; nonfusion surgery was performed in 7 patients.


RESULTS
Thirty-six female patients and 9 male patients formed the basis of the study. The mean age was 14 years, and the mean follow-up period was 31 months. Type 1 SSCM was in 15 patients, and type 2 SSCM was in 30 patients. Seven patients had progressive neurological deteriorations preoperatively. The mean major curves were corrected from an average of 73.7° to 33.5°, with a correction rate of 54.5%. The overall complication was transient, including 2 patients of neurological compromise and 1 patient of cerebrospinal fluid leakage. The average loss of correction at final follow-up was 2.5° for major curves.


CONCLUSIONS
The 1-stage surgical treatment of congenital spinal deformity associated with SSCM provides a satisfactory option to improve the spinal deformity without significant complications effectively. Neurosurgical interventions are recommended to patients with type 1 SSCM before spinal deformity surgery; however, patients with type 2 SSCM can be treated safely without a need of neurosurgical intervention.
Department of Orthopaedic Surgery, The Fourth Military Medical University, Xijing Hospital, Xi'an, Shaanxi, China.
Hua
H
Hui
Hui-Ren
HR
Tao
Xiao-Fan
XF
Jiang
Hong-Bin
HB
Fan
Ming
M
Yan
Zhuo-Jing
ZJ
Luo
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D009436:Neural Tube Defects / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010027:Osteotomy; D012189:Retrospective Studies; D012600:Scoliosis / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D013116:Spinal Cord / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult