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

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.

Changes in radiographic parameters following chiropractic treatment in 10 patients with adolescent idiopathic scoliosis: A retrospective chart review

This retrospective chart review was undertaken to investigate the role of chiropractic intervention for patients with adolescent idiopathic scoliosis (AIS). Ten cases of patients with AIS, mean age 13.3 years, undergoing chiropractic adjustment were retrospectively evaluated. Chart review was performed to extract age, medical history and treatment intervention. The magnitude of scoliosis was quantified using the Cobb method on standing radiographs. A comparison of the measurements from pre- and post-treatment radiographs revealed that Cobb angle reduced from average 29.7° down to average 23.4° (average 21.2% correction). Improvements in spinal morphologies were observed in most curves (64%, n=9/14) and curve stabilization in the rest (36%, n=5/14). A better correction was obtained in cases of mild and moderate AIS. In terms of stabilizing progression (≤5o curve progression) or correcting curvatures (≥6° reduction), radiological changes were observed in all patients.