Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium

Brooke Sadler PhD1, Alex Skidmore2, Jordan Gewirtz BS2, Richard C. E. Anderson MD17, Gabe Haller PhD2, Laurie L. Ackerman MD4, P. David Adelson MD5, Raheel Ahmed MD, PhD6, Gregory W. Albert MD7, Philipp R. Aldana MD8, Tord D. Alden MD9, Christine Averill MD2, Lissa C. Baird MD10, David F. Bauer MD, MPH11, Tammy Bethel-Anderson2, Karin S. Bierbrauer MD12, Christopher M. Bonfield MD43, Douglas L. Brockmeyer MD13, Joshua J. Chern MD, PhD14, Daniel E. Couture MD15, David J. Daniels MD, PhD16, Brian J. Dlouhy MD39, Susan R. Durham MD18, Richard G. Ellenbogen MD19, Ramin Eskandari MD20, Herbert E. Fuchs MD, PhD21, Timothy M. George MD22, Gerald A. Grant MD23, Patrick C. Graupman MD24, Stephanie Greene MD25, Jeffrey P. Greenfield MD, PhD26, Naina L. Gross MD27, Daniel J. Guillaume MD28, Todd C. Hankinson MD29, Gregory G. Heuer MD, PhD30, Mark Iantosca MD31, Bermans J. Iskandar MD6, Eric M. Jackson MD32, Andrew H. Jea MD4, James M. Johnston MD33, Robert F. Keating MD34, Nickalus Khan MD36, Mark D. Krieger MD37, Jeffrey R. Leonard MD38, Cormac O. Maher MD3, Francesco T. Mangano DO12, Timothy B. Mapstone MD27, J. Gordon McComb MD37, Sean D. McEvoy MD2, Thanda Meehan RN, BSN2, Arnold H. Menezes MD39, Michael Muhlbauer MD36, W. Jerry Oakes MD33, Greg Olavarria MD40, Brent R. O’Neill MD29, John Ragheb MD41, Nathan R. Selden MD, PhD10, Manish N. Shah MD42, Chevis N. Shannon DrPH43,47, Jodi Smith MD, PhD4, Matthew D. Smyth MD2, Scellig S. D. Stone MD, PhD44, Gerald F. Tuite MD45, Scott D. Wait MD46, John C. Wellons III MD, MSPH43,47, William E. Whitehead MD11, Tae Sung Park MD2, David D. Limbrick Jr. MD, PhD1,2, and Jennifer M. Strahle MD1,2,35
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  • 1 Department of Pediatrics, Washington University in St. Louis, MO;
  • | 2 Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO;
  • | 3 Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, MI;
  • | 4 Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN;
  • | 5 Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ;
  • | 6 Department of Neurological Surgery, University of Wisconsin at Madison, WI;
  • | 7 Division of Neurosurgery, Arkansas Children’s Hospital, Little Rock, AR;
  • | 8 Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FL;
  • | 9 Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, IL;
  • | 10 Department of Neurological Surgery and Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR;
  • | 11 Division of Pediatric Neurosurgery, Texas Children’s Hospital, Houston, TX;
  • | 12 Division of Pediatric Neurosurgery, Cincinnati Children’s Medical Center, Cincinnati, OH;
  • | 13 Division of Pediatric Neurosurgery, Primary Children’s Hospital, Salt Lake City, UT;
  • | 14 Division of Pediatric Neurosurgery, Children’s Healthcare of Atlanta, GA;
  • | 15 Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC;
  • | 16 Department of Neurosurgery, Mayo Clinic, Rochester, MN;
  • | 17 Department of Neurosurgery, Columbia University, New York, NY;
  • | 18 Department of Neurosurgery, University of Vermont, Burlington, VT;
  • | 19 Division of Pediatric Neurosurgery, Seattle Children’s Hospital, Seattle, WA;
  • | 20 Department of Neurosurgery, Medical University of South Carolina, Charleston, SC;
  • | 21 Department of Neurosurgery, Duke University, Durham, NC;
  • | 22 Division of Pediatric Neurosurgery, Dell Children’s Medical Center, Austin, TX;
  • | 23 Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital and Stanford University School of Medicine, Palo Alto, CA;
  • | 24 Division of Pediatric Neurosurgery, Gillette Children’s Hospital, St. Paul, MN;
  • | 25 Division of Pediatric Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA;
  • | 26 Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY;
  • | 27 Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK;
  • | 28 Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN;
  • | 29 Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO;
  • | 30 Division of Pediatric Neurosurgery, Children’s Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
  • | 31 Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA;
  • | 32 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD;
  • | 33 Division of Pediatric Neurosurgery, University of Alabama at Birmingham, AL;
  • | 34 Department of Neurosurgery, Children’s National Medical Center, Washington, DC;
  • | 35 Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO;
  • | 36 Department of Neurosurgery, Le Bonheur Children’s Hospital, Memphis, TN;
  • | 37 Department of Neurosurgery, Children’s Hospital Los Angeles, CA;
  • | 38 Division of Pediatric Neurosurgery, Nationwide Children’s Hospital, Columbus, OH;
  • | 39 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA;
  • | 40 Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL;
  • | 41 Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL;
  • | 42 Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TX;
  • | 43 Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN;
  • | 44 Division of Pediatric Neurosurgery, Boston Children’s Hospital, Boston, MA;
  • | 45 Department of Neurosurgery, Neuroscience Institute, All Children’s Hospital, St. Petersburg, FL;
  • | 46 Carolina Neurosurgery & Spine Associates, Charlotte, NC; and
  • | 47 Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN
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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.

ABBREVIATIONS

CM-I = Chiari malformation type I; PFD = posterior fossa decompression; PFDD = PFD with duraplasty; PFDo = PFD with extradural decompression only.

Supplementary Materials

    • Supplementary Tables 1–5 (PDF 432 KB)

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