Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium
Year: 2021
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS: A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS: In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS: In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.
Authors: Brooke Sadler, Alex Skidmore, Jordan Gewirtz, Richard C. E. Anderson, Gabe Haller, Laurie L. Ackerman, P. David Adelson, Raheel Ahmed, Gregory W. Albert, Philipp R. Aldana, Tord D. Alden, Christine Averill, Lissa C. Baird, David F. Bauer, Tammy Bethel-Anderson, Karin S. Bierbrauer, Christopher M. Bonfield, Douglas L. Brockmeyer, Joshua J. Chern, Daniel E. Couture, David J. Daniels, Brian J. Dlouhy, Susan R. Durham, Richard G. Ellenbogen, Ramin Eskandari, Herbert E. Fuchs, Timothy M. George, Gerald A. Grant, Patrick C. Graupman, Stephanie Greene, Jeffrey P. Greenfield, Naina L. Gross, Daniel J. Guillaume, Todd C. Hankinson, Gregory G. Heuer, Mark Iantosca, Bermans J. Iskandar, Eric M. Jackson, Andrew H. Jea, James M. Johnston, Robert F. Keating, Nickalus Khan, Mark D. Krieger, Jeffrey R. Leonard, Cormac O. Maher, Francesco T. Mangano, Timothy B. Mapstone, J. Gordon McComb, Sean D. McEvoy, Thanda Meehan, Arnold H. Menezes, Michael Muhlbauer, W. Jerry Oakes, Greg Olavarria, Brent R. O’Neill, John Ragheb, Nathan R. Selden, Manish N. Shah, Chevis N. Shannon, Jodi Smith, Matthew D. Smyth, Scellig S. D. Stone, Gerald F. Tuite, Scott D. Wait, John C. Wellons, William E. Whitehead, Tae Sung Park, David D. Limbrick, Jennifer M. Strahle
Institutions: Washington University in St. Louis, Columbia University, Indiana University Indianapolis, Indiana University School of Medicine, Barrow Neurological Institute, Phoenix Children's Hospital, University of Wisconsin–Madison, Arkansas Children's Hospital, University of Florida, University of Florida Health Science Center, Lurie Children's Hospital, Oregon Health & Science University, Doernbecher Children's Hospital, Texas Children's Hospital, Cincinnati Children's Hospital Medical Center, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Primary Children's Hospital, Children's Healthcare of Atlanta, Wake Forest University Health Sciences, Wake Forest University, Mayo Clinic, University of Iowa Hospitals and Clinics, University of Vermont, Seattle Children's Hospital, Medical University of South Carolina, Duke University, Dell Children's Medical Center of Central Texas, Lucile Packard Children's Hospital, Stanford University, Gillette Children's Specialty Healthcare, University of Pittsburgh, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, NewYork–Presbyterian Hospital, University of Oklahoma, University of Minnesota, Children's Hospital Colorado, University of Pennsylvania, Penn State Milton S. Hershey Medical Center, Johns Hopkins University, Johns Hopkins Medicine, University of Alabama at Birmingham, Children's National, Le Bonheur Children's Hospital, Children's Hospital Los Angeles, Nationwide Children's Hospital, University of Michigan, Michigan Medicine, Arnold Palmer Hospital for Children, University of Miami, Boston Children's Hospital, Johns Hopkins All Children's Hospital, Carolina Neurosurgery and Spine Associates
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3170433574