Matched analysis of traction-assisted posterior spinal correction in severe scoliosis with and without syringomyelia.

Abstract

To evaluate whether the presence of syringomyelia (SM) influences the efficacy of preoperative traction and final corrective outcomes in patients with severe scoliosis (SS) undergoing one-stage posterior spinal fusion. A retrospective matched study was conducted on 21 patients with severe scoliosis combined with syringomyelia (SS-SM) and 21 matched patients with severe idiopathic scoliosis (SIS), treated between 2007 and 2023. Patients were matched 1:1 based on sex, age, major curve type, Cobb angle, and number of curves. All patients underwent skull-femoral traction followed by one-stage posterior spinal correction. Radiographic parameters, surgical data, and neurological outcomes were compared between groups. No significant differences were found between the SS-SM and SIS groups in kyphosis angle, curve flexibility, traction correction rate, total correction rate, or the respective contributions of traction and surgery to the final correction (p > 0.05 for all). Both groups achieved over 50% correction through preoperative traction. Neurological complications were minimal and reversible, with no permanent deficits reported. Notably, the presence of SM did not increase the incidence of intraoperative neurophysiological monitoring abnormalities or postoperative neurological dysfunction. Preoperative traction followed by one-stage posterior correction is equally effective and safe for patients with SS-SM and SIS. The presence of syringomyelia does not adversely affect traction response or final surgical outcomes. These findings challenge the traditional view that prophylactic neurosurgical decompression is mandatory prior to scoliosis correction in SM patients, and support the feasibility of direct orthopedic intervention under strict selection criteria and neuromonitoring protocols.