Search

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]

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: A prospective study.Objective: To investigate the incidence and risk factors of acute pancreatitis after scoliosis surgery.Summary Of Background Data: Pancreatitis has been recognized as a possible complication of extra-abdominal surgeries. However, there were few reports on the incidence and risk factors of acute pancreatitis after scoliosis surgery.Methods: A prospective clinical study was performed at our center from September 2014 to October 2015. One hundred seventy-six patients undergoing posterior spinal correction surgery were enrolled. The diagnosis of acute pancreatitis was based on their clinical manifestations combined with laboratory examination. Demographic, intraoperative, and radiological parameters were evaluated to identify the risk factors of acute pancreatitis after scoliosis surgery.Results: Thirteen patients (7.4%) were diagnosed with acute pancreatitis. Compared with patients without pancreatitis, pancreatitis patients had lower body mass index (BMI) (15.5 vs. 19.5, P = 0.001), larger preoperative Cobb angle of major curve (87.5° vs. 59.2°, P < 0.001), lower correction rate (57.4% vs. 69.0%, P = 0.045), lower intraoperative mean arterial pressure (57.9 mmHg vs. 66.1 mmHg, P < 0.001), and longer fusion levels (13.3 vs. 10.1, P < 0.001). No significant differences were noted with respect to operation time, intraoperative blood loss, or the amount of sagittal profile correction. Furthermore, multivariate logistic analysis revealed that BMI (odds ratio [OR] = 1.542, P = 0.009), lowest intraoperative mean arterial pressure (OR = 1.126, P = 0.039), and segments of fusion (OR = 0.551, P = 0.025) were independent risk factors for postoperative acute pancreatitis. All cases were treated with bowel rest, intravenous fluids, and fasting and completely recovered with 3.3 (2-5) days.Conclusion: The incidence of postoperative acute pancreatitis after scoliosis surgery was 7.4%. The low BMI, lowest intraoperative mean arterial pressure, and long segments of fusion were independent risk factors for acute pancreatitis after scoliosis surgery.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]