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학술저널
저자정보
Shanmugasundaram Sivaraj (Orthopaedic Spine Manipal Hospital Salem India) Viswanathan Vibhu Krishnan (Ganga Medical Center and Hospital Coimbatore India) Shetty Ajoy Prasad (Ganga Medical Center and Hospital Coimbatore India) Rai Nimish (Ganga Medical Center and Hospital Coimbatore India) Hajare Swapnil (Ganga Medical Center and Hospital Coimbatore India) Kanna Rishi Mukesh (Ganga Medical Center and Hospital Coimbatore India) Rajasekaran Shanmuganathan (Department of Orthopaedics and Spine Surgery Ganga Hospital Coimbatore India)
저널정보
대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.17 No.1
발행연도
2023.2
수록면
156 - 165 (10page)
DOI
10.31616/asj.2021.0483

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Study Design: Retrospective cohort.Purpose: The current study was planned to evaluate deformity characteristics, assess relationship between morphology of syrinx/Arnold Chiari malformation (ACM) and deformity, analyze effect of posterior fossa decompression (PFD), and evaluate outcome.Overview of Literature: Scoliosis in ACM-I and syringomyelia (SM) is uncommon, and deformity characteristics differ from those seen in idiopathic scoliosis.Methods: Data regarding patients, who underwent PFD for ACM-I presenting with SM and scoliosis between January 2009 and December 2018, were retrospectively collected. Only patients with 2-year follow-up were included. Sagittal/coronal deformity and sagittal spinopelvic parameters were examined. Symmetry and extent of tonsillar descent, as well as morphology (configuration/variation) and extent of syrinx were determined.Results: A total of 42 patients (20 females; age: 14.2±5.8 years) were included; 35 patients (83.3%) had atypical curves. Mean preoperative coronal Cobb was 57.7°±20.9°; and 12 (28.6%) had significant coronal imbalance. Tonsillar descent was classified as grade 1, 2, and 3 in 16 (38.1%), 11 (26.2%), and 15 (35.7%) patients; 35 patients (83.3%) had asymmetric tonsillar descent; 17 (40.4%), 3 (7.1%), 16 (38.1%), and 6 (14.4%) had circumscribed, moniliform, dilated, and slender syrinx patterns; and 9 (21.4%), 12 (28.6%), and 21 (50%) of syrinx were right-sided, left-sided, and centric. There was no significant relationship between side of tonsillar dominance (<i>p</i> =0.31), grade of descent (<i>p</i> =0.30), and convexity of deformity. There was significant association between side of syrinx and convexity of scoliosis (<i>p</i> =0.01). PFD was performed in all, and deformity correction was performed in 23 patients. In curves ≤40°, PFD alone could stabilize scoliosis progression (<i>p</i> =0.02). There was significant reduction in syrinx/cord ratio following PFD (<i>p</i> <0.001).Conclusions: ACM-I+SM patients had atypical curve patterns in 83% of cases, and the side of syrinx deviation correlates with scoliosis convexity. Syrinx shrinks significantly following PFD. PFD may not stabilize scoliosis in curves >40°.

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