title: Prediction of Curve Progression After Posterior Fossa Decompression in Pediatric Patients With Scoliosis Secondary to Chiari Malformation.
abstract: OBJECTIVE
  In this retrospective radiographic and clinical study, we analyzed the evolution of scoliosis after posterior fossa decompression (PFD) to determine the predictors of curve progression after PFD in patients with scoliosis secondary to Chiari malformation type I (CM-I) and syringomyelia (SM). Institutional Review Board approval was obtained to conduct the study. Previous studies have shown that PFD can improve the associated scoliosis in some patients with CM-I, and certain clinical factors can predict curve progression after PFD. However, the results were often contradictory.
  
  
  METHODS
  In our study, 54 patients with CM-I who underwent a standard PFD were divided into 2 groups according to the evolution of scoliosis after PFD. One group consisted of "progressors" with curve progression of more than 5° from before PFD to the final follow-up; the other group consisted of "nonprogressors" with curve stabilization or improvement. Clinical and radiographic data were compared between progressors and nonprogressors.
  
  
  RESULTS
  Twenty-five of the patients received brace treatment, and 11 patients underwent spinal fusion. Nineteen patients were identified as progressors, and 35 were nonprogressors. Age, curve type, curve magnitude, and bracing treatment were independent predictors for curve progression after PFD. Both an age ≥ 10.5 years and a Cobb angle ≥ 44.5° were strongly predictive factors for curve progression. Regarding those patients with an indication for bracing, a significant difference (p=.009) was noted in terms of the evolution of scoliosis between patients with and without bracing treatment.
  
  
  CONCLUSIONS
  PFD had an effect on the regression of scoliosis in 64.8% of the CM-I patients. An age ≥ 10.5 years, a Cobb angle ≥ 44.5°, and double curves were factors that could predict the progression of scoliosis in these patients. Additionally, we advocate that bracing treatment may be effective in some skeletally immature patients.
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Zezhang
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Song
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Huang
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
authors.forename: Shifu
authors.initials: S
authors.lastname: Sha
authors.affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China. Electronic address: scoliosis2002@sina.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
keywords: Chiari malformation; Decompression; Progression; Scoliosis; Syringomyelia