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Spine (Phila Pa 1976). 2004 Feb 1;29(3):286-92.

Predictors of progression of scoliosis after decompression of an Arnold Chiari I malformation.

Author information

1
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. flynnj@email.chop.edu

Abstract

STUDY DESIGN:

Retrospective study of patients with scoliosis and an Arnold Chiari I malformation requiring operative management.

OBJECTIVES:

Determine the factors that could predict whether a particular spinal deformity might progress despite neurosurgical management of Arnold Chiari I malformation.

SUMMARY OF BACKGROUND DATA:

Few studies have documented the relationship between diagnosis and treatment of Arnold Chiari I malformation and associated spinal deformities. Most studies mix neural axis abnormalities and contain limited information about the spinal deformity.

METHODS:

Medical records, radiographs, and magnetic resonance images of patients were evaluated focusing on age and findings at presentation, characteristics of presenting and follow-up spinal deformities, and the specifics of neurosurgical and orthopedic management. Patients were divided into two groups: those whose curves progressed >10 degrees or to surgical range (largest curve >45 degrees ) after neurosurgical intervention (progressors) and those whose curves stabilized or decreased (nonprogressors).

RESULTS:

Eight progressors presented at an average age of 11.4 years (range 2-19) and were followed for 6.3 years (range 2-15). Seven nonprogressors presented at 6.5 years of age (range 5-10) and were followed for 6.6 years (range 3.5-14). Neurosurgical procedures were equivalent in both groups; however, surgical revisions were required in 3 out of 8 progressors and 1 out of 7 nonprogressors. All progressors had a double scoliosis curve; but only one nonprogressor had a double curve. Six out of 8 progressors and 0 out of 7 nonprogressors had a rotation >or=2+ and 50% of progressors had a thoracic kyphosis >50 degrees compared to 1 out of 7 nonprogressors.

CONCLUSIONS:

In this series, progression of spinal deformity after neurosurgical management of Arnold Chiari I malformation was associated with later age at neurosurgical decompressions and initial neurologic symptoms, double scoliosis curve patterns, kyphosis, rotation, and larger curve at presentation.

PMID:
14752351
[Indexed for MEDLINE]

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