[Natural history of scoliosis after posterior fossa decompression in patients with Chiari malformation/syringomyelia].
OBJECTIVE
To explore the natural history of scoliosis after posterior fossa decompression (PFD) in patients with Chiari malformation/syringomyelia and examine the risk factors associated with curve progression.


METHODS
A retrospective radiographic study was performed at our scoliosis center for 26 patients undergoing PFD for Chiari malformation between January 2002 and December 2007. Their clinical and radiological parameters, including age, curve magnitude, curve pattern, extent of cerebellar tonsil herniation, maximal syrinx/cord ratio, syrinx size and length, were evaluated pre- and postoperatively. Curve progression was defined as an increment of Cobb angle over 5° compared with that of initial curve (progression group); whereas an increment of Cobb angle equal to or under 5° was considered curve stabilization or improvement (non-progression group). All aforementioned parameters at the time of PFD were compared between two groups with Student t and Fisher exact tests.


RESULTS
Their average initial age, curve magnitude and follow-up duration were 10.3 ± 2.4 (6.5-14.7) years, 33.5° ± 7.7° (20°-45°) and 57.5 ± 26.9 (24-118) months respectively. At the final follow-up, curve improvement or stabilization occurred in 11 (42%) patients. Compared with the non-progression group, significantly greater initial age was observed in the progression group (11.1 ± 2.2 vs 9.2 ± 2.2 years, P = 0.041). In addition, the percentage of double major curve was significantly higher in the progression group than that in the non-progression group (26.7% vs 9.1%, P = 0.037). With regards to Cobb angle, Risser sign, extent of cerebellar tonsil herniation, maximal syrinx/cord ratio, syrinx length, sagittal parameters and percentage of patients with preoperative neurological signs or symptoms, no significant differences existed between two groups (P > 0.05).


CONCLUSIONS
PFD may halt curve progression in 42% of patients with Chiari malformation/syringomyelia. And those with older age or double major curves are more likely to experience the progression of scoliosis during the post-PFD course.
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Shifu
S
Sha
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China. Email: zhuzezhang@126.com.
Zezhang
Z
Zhu
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Yong
Y
Qiu
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Xu
X
Sun
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Bangping
B
Qian
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Zhen
Z
Liu
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Huang
H
Yan
Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
Long
L
Jiang
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000601:surgery*; D002648:Child; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology; D013595:Syringomyelia / Q000150:complications / Q000601:surgery*