Spinal-Shortening Process Positively Improves Associated Syringomyelia in Patients with Scoliosis After Single-Stage Spinal Correction.

Abstract

Single-stage spinal correction without previous neurosurgical intervention has been attempted in patients with scoliosis associated with syringomyelia (SM). However, evidence to demonstrate its potential influence on associated SM from direct spinal correction is still lacking. The aim of the present study was to explore the role of spinal shortening in the prognosis of SM-associated scoliosis after single-stage spinal correction without previous neurosurgical intervention. Patients with SM-associated scoliosis without previous neurological intervention, who had undergone posterior direct instrumental correction (PDIC) without osteotomy and posterior vertebral column resection (PVCR) at a single center, were selected for comparative analysis. The basic demographic and pre- and postoperative imaging data of the spinal deformity and SM at the final follow-up were compared separately for the 2 different spinal correction procedures. A total of 23 patients were included in the final analysis: 13 had undergone PDIC and 10 had undergone PVCR. The mean follow-up period was 6.2 years (range, 5-9 years). At the final follow-up, the mean corrective rate of scoliosis and kyphosis was 65.7% and 48.4%, respectively. Obvious SM reduction was achieved in 11 patients (47.8%), with an average reduction of 37.3%. No patient experienced neurologic deterioration or had required further neurosurgical intervention for SM during follow-up. The patients who had undergone PVCR had had much more severe scoliosis (98.8° vs. 60.5°; P = 0.000) and kyphosis (74.8° vs. 43.6°; P = 0.032). Moreover, 80.0% of the patients who had undergone PVCR had experienced obvious SM improvement compared with 23.1% of those who had undergone PDIC (P = 0.007). The reduction of spinal cord tension is an important factor influencing SM improvement. As the most powerful spinal-shortening osteotomy, PVCR can effectively correct severe spinal deformities and improve associated SM. Single-stage posterior spinal correction can be a potential choice for selected patients with scoliosis and untreated SM using strict inclusion criteria, which will not only achieve safe spinal correction but could also steadily improve and stabilize SM.