Therapeutic and diagnostic protocol for the

treatment of scoliosis associated with Syringomyelia

Francesco Lolli, Konstantinos Martikos, Francesco Vommaro, Alfredo Cioni,

Mario Di Silvestre, Stefano Giacomini, Tiziana Greggi

Surgery of Spinal DeformitiesRizzoli Orthopaedic Institute

Bologna, Italy

The purpose of this study is provide a safe diagnostic and therapeutic procedure to treat scoliosis in syringomyelia.

INTRODUCTION

Scoliosis can be associated with syringomyelia… reported incidence varies between 25%-85%

On the other hand, syringomyelia is associated with surgical scoliosis in 2% of the cases

Materials and Methods

Thirty seven patients with scoliosis in syringomyelia were treated from 1975 to 2010

24 females and 13 males

Age from 1 to 52 years

Mean follow-up 42.6 months (range 4 to 180 months)

Scoliosis was diagnosed before the age of 10 in 22 out of 37 cases The main curve of was left thoracic or thoracolumbar Syringomyelia was most often detected in the thoracic region

Materials and Methods

Peripheral neurological deficits (19 subjects) Pain (14 subjects) 13 cases presented no symptoms

Frequently observed clinical manifestations

correction and posterior instrumented arthrodesis in 10 patients

anterior arthrodesis in 1 patient

arthrodesis by double approach in 1 patient

Surgery

Syringomyelia was surgically treated in 12 patients Scoliosis was operated in 12 cases

spino-costal distractor from the age of 9 until the age of 11 in 1 case

Evaluation of clinical and radiographical data of the patients with scoliosis in syringomyelia showed associated malformations in 27 patients

Results

Arnold Chiari in 13 patients

Congenital malformations of the spine in 11 patients

Tethered cord in 7 patients

Kidney dysplasia in 2 patients

Hydrocephalus 2 patients

9 patients had more than 1 associated malformation

Results At follow up, excellent outcome in one patient instrumented with spino-costal distractor from the age of 9 until the age of 11, when he was instrumented posteriorly with pedicle screws

Very good out come in 4 cases who underwent posterior arthrodesis in the adolescence

Good out come with stable correction in 6 cases, although over time revision of instrumentation was necessary in 4 patients

Junctional kyphosis due to C6 subluxation with onset of spastic tetraparesis was observed in 1 patient.

One patient with hydrocephalus showed worsening of neurological impairement in the postoperative.

MRI can provide surgeons with useful information for the preoperative planning of a scoliosis and becomes mandatory when facing either a rapidly progressive curve in juvenile age

Neurological evaluation should be recommended to complete the preoperative clinical picture, as well as pre- and intraoperative SSEP (somato-sensitive evoced potentials) and MEP (motor evoced potentials)

If MRI shows myeloradicular malformations, a neurosurgical assessment becomes mandatory.

Our experience allows us to state that the diagnostic-therapeutic must be part of the scientific and cultural background of the surgeon who deals with spinal deformity of the spine

Conclusions

None of the authors has any potential conflict of interest