Neurosurgical causes of scoliosis in patients with myelomeningocele: an evidence-based literature review

View More View Less
  • 1 Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Scoliosis in children with myelomeningocele occurs frequently and is multifactorial in origin. The aim of this paper is to review the evidence regarding the causal association, if any, between isolated scoliosis and spinal cord tethering, Chiari malformation, or syringomyelia in this population.

Methods

A Medline search of the English-language literature from 1966 to 2002 was undertaken. All of the pertinent articles that were identified underwent careful review to determine the strength of the evidence supporting the claim that isolated scoliosis in children with myelomeningocele is related to spinal cord tethering, Chiari malformation, or syringomyelia. The strength of the evidence was graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence (May 2001). A survey was also sent to practicing pediatric neurosurgeons and the returned responses were evaluated.

Conclusions

All available studies were classified as Level 4 studies (case series and flawed cohort and case-control studies). Based on the strength of the available data, there may be an association between spinal cord tethering and scoliosis, particularly in those patients with upper lumbar lesions and spinal curves less than 45°. There is little evidence to support a causal relationship between scoliosis and Chiari malformation or syringomyelia in this population.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Banta JV, & Becker GT: The natural history of scoliosis in myelomeningocele. Orthop Trans 10:18, 1986 (Abstract) Banta JV,Becker GT: The natural history of scoliosis in myelomeningocele. Orthop Trans 10:18, 1986 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 2.

    Boemers TM, , Soorani-Lunsing IJ, , de Jong TP, & Pruijs HE: Urological problems after surgical treatment of scoliosis in children with myelomeningocele. J Urol 155:10661069, 1996 Boemers TM, Soorani-Lunsing IJ, de Jong TP, Pruijs HE: Urological problems after surgical treatment of scoliosis in children with myelomeningocele. J Urol 155:1066–1069, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Bowman RM, , McLone DG, , Grant JA, , Tomita T, & Ito JA: Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34:114120, 2001 Bowman RM, McLone DG, Grant JA, Tomita T, Ito JA: Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34:114–120, 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Brinker MR, , Rosenfeld SR, , Feiwell E, , Granger SP, , Mitchell DC, & Rice JC: Myelomeningocele at the sacral level. Long-term outcomes in adults. J Bone Joint Surg Am 76:12931300, 1994 Brinker MR, Rosenfeld SR, Feiwell E, Granger SP, Mitchell DC, Rice JC: Myelomeningocele at the sacral level. Long-term outcomes in adults. J Bone Joint Surg Am 76:1293–1300, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Hall PV, , Lindseth RE, , Campbell RL, & Karlsbeck JE: Myelodysplasia and developing scoliosis. A manifestation of syringomyelia. Spine 1:4856, 1976 Hall PV, Lindseth RE, Campbell RL, Karlsbeck JE: Myelodysplasia and developing scoliosis. A manifestation of syringomyelia. Spine 1:48–56, 1976

    • Search Google Scholar
    • Export Citation
  • 6.

    Hardwidge C, & Williams B: Spina bifida and syringomyelia. Childs Nerv Syst 8:173, 1992 (Abstract) Hardwidge C, Williams B: Spina bifida and syringomyelia. Childs Nerv Syst 8:173, 1992 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 7.

    Herman JM, , McLone DG, , Storrs BB, & Dauser RC: Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg 19:243249, 1993 Herman JM, McLone DG, Storrs BB, Dauser RC: Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg 19:243–249, 1993

    • Search Google Scholar
    • Export Citation
  • 8.

    Hoffman HJ, , Neill J, , Crone KR, , Hendrick EB, & Humphreys RP: Hydrosyringomyelia and its management in childhood. Neurosurgery 21:347351, 1987 Hoffman HJ, Neill J, Crone KR, Hendrick EB, Humphreys RP: Hydrosyringomyelia and its management in childhood. Neurosurgery 21:347–351, 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Keessen W, , van Ooy A, , Pavlov P, , Pruijs JE, , Scheers MM, & Slot G, et al: Treatment of spinal deformity in myelomeningocele: a retrospective study in four hospitals. Eur J Pediatr Surg 2 (Suppl 1):1822, 1992 Keessen W, van Ooy A, Pavlov P, Pruijs JE, Scheers MM, Slot G, et al: Treatment of spinal deformity in myelomeningocele: a retrospective study in four hospitals. Eur J Pediatr Surg 2 (Suppl 1):18–22, 1992

    • Search Google Scholar
    • Export Citation
  • 10.

    La Marca F, , Herman M, , Grant JA, & McLone DG: Presentation and management of hydromyelia in children with Chiari type-II malformation. Pediatr Neurosurg 26:5767, 1997 La Marca F, Herman M, Grant JA, McLone DG: Presentation and management of hydromyelia in children with Chiari type-II malformation. Pediatr Neurosurg 26:57–67, 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Mackel JL, & Lindseth RF: Scoliosis in myelodysplasia. J Bone Joint Surg Am 57:1031, 1975 (Abstract) Mackel JL, Lindseth RF: Scoliosis in myelodysplasia. J Bone Joint Surg Am 57:1031, 1975 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 12.

    McLone DG, , Herman JM, , Gabrieli AP, & Dias L: Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:813, 1990/1991 McLone DG, Herman JM, Gabrieli AP, Dias L: Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13, 1990/1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Müller EB, & Nordwall A: Brace treatment of scoliosis in children with myelomeningocele. Spine 19:151155, 1994 Müller EB, Nordwall A: Brace treatment of scoliosis in children with myelomeningocele. Spine 19:151–155, 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Müller EB, & Nordwall A: Prevalence of scoliosis in children with myelomeningocele in western Sweden. Spine 17:10971102, 1992 Müller EB, Nordwall A: Prevalence of scoliosis in children with myelomeningocele in western Sweden. Spine 17:1097-–1102, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Müller EB, , Nordwall A, & Odén A: Progression of scoliosis in children with myelomeningocele. Spine 19:147150, 1994 Müller EB, Nordwall A, Odén A: Progression of scoliosis in children with myelomeningocele. Spine 19:147–150, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Müller EB, , Nordwall A, & von Wendt L: Influence of surgical treatment of scoliosis in children with spina bifida on ambulation and motoric skills. Acta Paediatr 81:173176, 1992 Müller EB, Nordwall A, von Wendt L: Influence of surgical treatment of scoliosis in children with spina bifida on ambulation and motoric skills. Acta Paediatr 81:173–176, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Oxford Centre for Evidence-Based Medicine: Levels of Evidence. (http://www.cebm.net/levels_of_evidence.asp#levels) [Accessed 6 January 2005] Oxford Centre for Evidence-Based Medicine: Levels of Evidence. (http://www.cebm.net/levels_of_evidence.asp#levels) [Accessed 6 January 2005]

    • Search Google Scholar
    • Export Citation
  • 18.

    Park TS, , Cail WS, , Maggio WM, & Mitchell DC: Progressive spasticity and scoliosis in children with myelomeningocele. Radiological investigation and surgical treatment. J Neurosurg 62:367375, 1985 Park TS, Cail WS, Maggio WM, Mitchell DC: Progressive spasticity and scoliosis in children with myelomeningocele. Radiological investigation and surgical treatment. J Neurosurg 62:367–375, 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Pierz K, , Banta J, , Thomson J, , Gahm N, & Hartford J: The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 20:362365, 2000 Pierz K, Banta J, Thomson J, Gahm N, Hartford J: The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 20:362–365, 2000

    • Search Google Scholar
    • Export Citation
  • 20.

    Piggott H: The natural history of scoliosis in myelodysplasia. J Bone Joint Surg Br 62:5458, 1980 Piggott H: The natural history of scoliosis in myelodysplasia. J Bone Joint Surg Br 62:54–58, 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Reigel DH, , Tchernoukha K, , Bazmi B, , Kortyna R, & Rotenstein D: Change in spinal curvature following release of tethered spinal cord associated with spina bifida. Pediatr Neurosurg 20:3042, 1994 Reigel DH, Tchernoukha K, Bazmi B, Kortyna R, Rotenstein D: Change in spinal curvature following release of tethered spinal cord associated with spina bifida. Pediatr Neurosurg 20:30–42, 1994

    • Search Google Scholar
    • Export Citation
  • 22.

    Samuelsson L, , Bergström K, , Thuomas KA, , Hemmingsson A, & Wallensten R: MR imaging of syringohydromyelia and Chiari malformations in myelomeningocele patients with scoliosis. AJNR Am J Neuroradiol 8:539546, 1987 Samuelsson L, Bergström K, Thuomas KA, Hemmingsson A, Wallensten R: MR imaging of syringohydromyelia and Chiari malformations in myelomeningocele patients with scoliosis. AJNR Am J Neuroradiol 8:539–546, 1987

    • Search Google Scholar
    • Export Citation
  • 23.

    Samuelsson L, & Eklöf O: Scoliosis in myelomeningocele. Acta Orthop Scand 59:122127, 1988 Samuelsson L, Eklö O: Scoliosis in myelomeningocele. Acta Orthop Scand 59:122–127, 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Sarwark JF, , Weber DT, , Gabrieli AP, , McLone DG, & Dias L: Tethered cord syndrome in low motor level children with myelomeningocele. Pediatr Neurosurg 25:295301, 1996 Sarwark JF, Weber DT, Gabrieli AP, McLone DG, Dias L: Tethered cord syndrome in low motor level children with myelomeningocele. Pediatr Neurosurg 25:295–301, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Shurtleff DB, , Goiney R, , Gordon LH, & Livermore N: Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report. Dev Med Child Neurol Suppl 37:126133, 1976 Shurtleff DB, Goiney R, Gordon LH, Livermore N: Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report. Dev Med Child Neurol Suppl 37:126–133, 1976

    • Search Google Scholar
    • Export Citation
  • 26.

    Stella G, , Ascani E, , Cervellati S, , Bettini N, , Scarsi M, & Vicini M, et al: Surgical treatment of scoliosis associated with myelomeningocele. Eur J Pediatr Surg 8 (Suppl 1):2225, 1998 Stella G, Ascani E, Cervellati S, Bettini N, Scarsi M, Vicini M, et al: Surgical treatment of scoliosis associated with myelomeningocele. Eur J Pediatr Surg 8 (Suppl 1):22–25, 1998

    • Search Google Scholar
    • Export Citation
  • 27.

    Wisoff JH, & Epstein F: Management of hydromyelia. Neurosurgery 25:562571, 1989 Wisoff JH, Epstein F: Management of hydromyelia. Neurosurgery 25:562–571, 1989

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 538 109 11
Full Text Views 98 4 0
PDF Downloads 125 7 0
EPUB Downloads 0 0 0