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Background: Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of earlyonset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT. Methods: A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed. Results: A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion. Conclusions: In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Both patients with Chiari-I malformation (CIM) with syringomyelia and those with idiopathic syringomyelia (ISm) have a syrinx and can have scoliosis as well. However, there is no literature regarding differences between CIM and ISm in terms of radiographic outcomes and surgical complications after posterior fusion, to our knowledge. The aim of the present study was to compare radiographic features, clinical outcomes, and surgical complications after posterior spinal fusion between patients with CIM-associated scoliosis and those with ISm-associated scoliosis.Methods: One hundred and twenty patients with syringomyelia-associated scoliosis were retrospectively analyzed. Twenty-one patients with scoliosis secondary to CIM were enrolled and matched by sex, age, and the Cobb angle of the scoliotic curve with 21 patients with scoliosis secondary to ISm. All patients underwent 1-stage posterior fusion surgery. Coronal and sagittal radiographic parameters were evaluated before surgery, immediately after surgery, and at the final follow-up (at least 2 years). We also collected data regarding syringeal features, neurological deficits, intraoperative neuromonitoring, and complications.Results: Sex, age, preoperative coronal/sagittal scoliosis parameters, and neurological deficits were similar between the matched CIM and ISm groups. On average, the CIM group had a longer syrinx (12.3 ± 3.6 versus 8.9 ± 4.5 vertebral levels, p = 0.010) than the ISm group. The CIM and ISm groups showed similar correction rates for primary curves (70.9% ± 10.6% versus 69.5% ± 16.3%, p = 0.739). There were no significant differences in coronal/sagittal correction, intraoperative neuromonitoring abnormalities, surgical complications, or Scoliosis Research Society-22 questionnaire scores between the 2 groups.Conclusions: Despite matched demographic and scoliotic coronal parameters, patients with CIM had longer syrinxes compared with patients with ISm. One-stage posterior fusion achieved comparable clinical and radiographic outcomes for both CIM- and ISm-associated scoliosis without significant differences in neurological complications.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study.Objective: To compare syrinx characteristics, scoliotic parameters, and neurological deficits between Chiari I malformation (CIM) and idiopathic syringomyelia (IS) in the scoliotic population.Summary Of Background Data: CIM and IS are common in neuromuscular scoliosis patients; however, differences in syrinx characteristics, scoliotic parameters, and neurological deficits between CIM and IS are unclear.Methods: Thirty-six patients with scoliosis secondary to CIM were enrolled retrospectively and matched with 36 IS patients for sex, age, scoliosis classification, and Cobb angle. Information on radiographic features of scoliosis and syrinx and neurological deficits was systematically collected.Results: Sex, age, and coronal, and sagittal scoliosis parameters did not differ between the CIM and IS groups. The CIM group had a longer syrinx (12.9 ± 4.0 vertebral levels vs. 8.7 ± 5.5 vertebral levels, P < 0.001), a higher cranial extent (3.6 ± 2.2 vs. 5.2 ± 3.5, P = 0.027), and a lower caudal extent (15.6 ± 2.9 vs. 13.0 ± 4.6, P = 0.006) than the IS group, despite no differences in syrinx/cord (S/C) ratio or syrinx classification. No differences in neurological deficits were identified between the CIM and IS patients.Conclusion: With demographic and scoliotic coronal parameters matched, the CIM patients had a longer syrinx, located at a higher cranial and lower caudal level, compared with the IS group. No significant differences in syrinx S/C ratio, sagittal features of scoliosis, or neurological deficits were detected between the two groups.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making.Methods: Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B).Results: There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030).Conclusions: The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis. An osseous spur at the apex of the scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study.Objective: To compare the clinical outcomes of different surgical strategy for patients with congenital scoliosis (CS) and type I split cord malformation (SCM).Summary Of Background Data: CS associated with type I SCM is a challenge for spine surgeon because of the high potential rate of neurological compromise. Traditionally, bony spur resection (BR) has been indicated before any procedure for scoliosis correction.Methods: From May 2002 to February 2013, 82 CS patients with type I SCM who underwent corrective surgery at our center were retrospectively reviewed. There were 20 male and 62 female patients with an average age of 13.8 years (4-39 yrs) at surgery. They were divided into two groups according to different surgical strategy. The patients in the BR group underwent staged prophylactic neurosurgery or one-stage BR before corrective surgery, whereas patients in the nonresection (NR) group underwent one-stage corrective surgery without addressing bony spur.Results: There were 15 patients in the BR group and 67 patients in the NR group. No significant differences were detected in preoperative characteristics between two groups. The average follow up was 37 months (24-105 months). In the BR group, the correction rate was 53.0% and 45.9% at the final follow up. Whereas, in the NR group, the correction rate was 48.5% and 42.1% at the final follow up. Compared with the NR group, the operation time and blood loss were statistically higher in the BR group. Five patients experienced transient neurological complications and one patient in the BR group suffered permanent neurological damage of incomplete loss bladder control.Conclusion: One-stage corrective surgery could be safe and effective for patients with CS and SCM. For patients with intact or stable neurological status, prophylactic neurosurgical intervention to remove bony spur before curve correction may not be necessary.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background: The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction.Methods: This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering.Results: On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p < 0.05). In the type-I group, the correction rate was 48.9% at 1 week postoperatively and 42.2% at the last follow-up. In the type-II group, the correction rate was 54.7% at 1 week postoperatively and 47.9% at the last follow-up. Eleven (5.1%) of the patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up.Conclusions: Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological intervention. For such patients with intact or stable neurological status, prophylactic detethering prior to scoliosis surgery may not be necessary.Level Of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective study of a series of 226 consecutive Chinese patients with congenital scoliosis. Objective. To identify the incidence of intraspina] abnormalities and other organ defects in surgical patients with congenital scoliosis in Chinese population. Summary of Background Data. Previous studies have revealed high rates of intraspinal anomalies and other organ defects in patients with congenital scoliosis. The incidence of abnormalities in patients with congenital scoliosis in Chinese population has not been reported. Methods. A total of 226 patients with congenital scoliosis underwent surgical treatment in Peking Union Medical College Hospital between January 2005 and March 2011 were identified. A definitive diagnosis of congenital scoliosis for all patients was made. Complete data were reviewed, including medical records, plain radiograph, magnetic resonance (MR) image of the whole spine, echocardiography, and renal ultrasound. The incidence of intraspinal abnormalities and other organ defects were analyzed. Results. Intraspina[ abnormalities were found in 99 (43%) patients. Diastematomydia was identified to be the most common intraspinal pathological anomaly, which was different from the previous reports. The incidence of intraspinal anomaly in patients with failures of segmentation and mixed defects were significantly higher than those with failures of formation. Patients with thoracic hemivertebrae were found to have a higher incidence of intraspinal abnormalities than patients with lumbar hemivertebrae. Patients with intraspinal abnormality had a higher incidence of positive clinical findings than those with normal magnetic resonance imaging. However, the difference between the 2 groups was not statistically significant. Other organic defects were found in 91(40%) patients. Cardiac defects were detected in 18%, urogenital anomalies in 12%, and gastrointestinal anomalies in 5% of the patients in this study. Conclusion. Diastematomyelia was found to be the most common intraspinal pathological anomaly and cardiac defects were the most common extraspinal anomaly in surgical patients with congenital scoliosis in this study. Magnetic resonance imaging, echocardiography, and ultrasound should be part of routine evaluation in all congenital cases before surgery, no matter positive clinical findings were found or not. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: A randomized prospective study.OBJECTIVE.: To compare safety, efficacy, and cost between 1-stage and 2-stage anterior and posterior spinal fusion in treating rigid thoracic adolescent idiopathic scoliosis (AIS).SUMMARY OF BACKGROUND DATA.: Retrospective study issued different outcomes comparing 1-stage with 2-stage surgical procedures in treating neuromuscular and congenital scoliosis. A randomized prospective study in AIS has rarely been reported.METHODS.: Twenty-four patients were randomly divided into 2 groups. Group A underwent a 2-stage procedure, group B a 1-stage procedure. Inclusion criteria were: (1) AIS; (2) rigid single thoracic curve, ≥90° on anteroposterior and ≥60° on side bending view; and (3) pulmonary function tests, vital capacity ≥500 mL or FEV1 ≥50%. Exclusion criteria were: (1) curves either <90° on anteroposterior or <60° on bending view; and (2) pulmonary function tests, both vital capacity <500 mL and FEV1 <50%. The mean follow up was 3.3 years (range 2–5.1). Clinical outcomes between the 2 groups were analyzed.RESULTS.: A statistical t test demonstrated no significant difference in age (P = 0.299), curves on anteroposterior (P = 0.908), on bending (P = 0.905), after surgery (P = 0.699), and at last follow-up (P = 0.946). No significant difference in blood loss (P = 0.089), transfusion (P = 0.334), operation time (P = 0.172), fusion segments anterior (P = 0.161), posterior (P = 0.546), wound drainage (P = 0.557), thoraco drainage (P = 0.948), and loss of correction at follow-up (P = 0.596). However, significant differences were found in length of stay (P < 0.001), patient cost of hospitalization (P < 0.001) between 2 groups, and curve correction (P < 0.001) in each group. Perioperative complications included 1 patient each with pneumonia, pneumothorax (group A), and ileus (group B). Screw nut loosing was found in 1 patient in group B, but no curve deteriorated. No neurologic deficit occurred in either group.CONCLUSION.: A comparison of 1-stage versus 2-stage fusion in treating rigid thoracic curves in AIS did not show significant differences in safety or efficacy but did demonstrate significant difference in length of stay and patient cost. [ABSTRACT FROM AUTHOR]