Do untreated intraspinal anomalies in congenital scoliosis impact the safety and efficacy of spinal correction surgery? A retrospective case-control study

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OBJECTIVE

Intraspinal anomalies associated with congenital scoliosis (CS) complicate the decision-making process for spinal correction surgery in CS patients. Recently, deformity correction surgery without prior prophylactic neurological intervention has been recognized to be safe in CS patients with intact or stable neurological status. However, no case-control study has identified the surgical outcomes and risks of spinal correction surgery in this patient population. The authors sought to investigate the safety and efficacy of spinal correction surgery for CS associated with untreated intraspinal anomalies (split cord malformation [SCM], tethered cord, and/or syringomyelia) with intact or stable neurological status.

METHODS

A group of CS patients with intraspinal anomalies (CS+IA) and another group of CS patients without intraspinal anomalies (CS-IA) undergoing 1-stage posterior correction surgery were retrospectively reviewed. The radiographic and clinical outcomes and postoperative complications were compared between the 2 groups.

RESULTS

There were 57 patients in the CS+IA group and 184 patients in the CS-IA group. No significant difference was observed in age, sex, spinal curve pattern, main Cobb angle, and flexibility of the main curve between the 2 groups (p > 0.05 for all). The postoperative correction rates of the major curve were comparable between the 2 groups (53.5% vs 55.7% for the CS+IA and CS-IA groups, respectively, p > 0.05). No significant difference was observed in the incidence of either implant-related or neurological complications between 2 groups. No patients in the CS+IA group developed neurological complications, whereas 1 patient in the CS-IA group experienced transient weakness of the left lower extremity after surgery.

CONCLUSIONS

Coexisting intraspinal anomalies (SCM, tethered cord, and/or syringomyelia) in CS patients with normal or stable neurological status do not significantly increase the risk of neurological complications of correction surgery. Prophylactic neurosurgical intervention for intraspinal anomalies before correction surgery might be unnecessary for these patients.

ABBREVIATIONS CS = congenital scoliosis; CS+IA group = CS patients with intraspinal anomalies; CS-IA group = CS patients without intraspinal anomalies; SCM = split cord malformation.

Article Information

Correspondence Zezhang Zhu: Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. zhuzezhang@126.com.

INCLUDE WHEN CITING Published online April 5, 2019; DOI: 10.3171/2019.1.SPINE181205.

Q.Z. and B.S. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A 13-year-old female asymptomatic CS patient with a type 1 SCM underwent posterior correction and fusion. The major thoracic curve was 65° at preoperation (A and B) and the preoperative MRI and CT showed type 1 SCM (C and D). Postoperatively, the major thoracic curve improved to 28° (E and F). At 2 years’ follow-up, the patient’s neurological status was intact and the scoliosis correction was well maintained (G and H).

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