Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
Spine (Phila Pa 1976). 2009 Oct 15;34(22):2413-8. doi: 10.1097/BRS.0b013e3181b9c61b.
Retrospective case series.
To evaluate the necessity of neurosurgical interventions for split cord malformations (SCMs) before correction and instrumentation for patients with congenital spinal deformity(CSD)s.
SCMs are commonly associated with CSD. As pathology of SCMs understood well, the common belief of all SCM must be operated before any orthopedic intervention is needed to be revised.
Sixty-one consecutive patients with CSD and spinal dysraphism treated by correction and posterior instrumentation between 1994 and 2005 were retrospectively evaluated. Inclusion criteria were patients with CSD and SCM, who were treated with long segment instrumentation (more than 6 functional units) with at least 2 years of follow-up. Thirty-two patients (8 male and 24 female) with an age average of 11 years +8 months (4-18 years) fulfilled the criteria. While all patients with Type I SCM were managed with neurosurgical intervention (spur excision and dural reconstruction) before corrective surgery, Type II SCM cases were treated by instrumented fusion without neurologic intervention.
There were 18 patients with Type I and 14 patients with Type II SCM. The average follow-up was 52 (24-144) months. The correction rate of deformity was 44% in type I and 47% in Type II SCM. Two patients with Type II SCM had transient neurologic deterioration while there were no neurologic events in patients with Type II SCM.
Due to high incidence of SCMs, all patients with CSDs must be evaluated with MRI, before surgery. Neurosurgical interventions are recommended even for neurologically asymptomatic Type I SCM before spinal deformity surgery; however, patients with Type II SCM can be treated safely without a need of neurosurgical intervention.
回顾性病例系列研究。
评估先天性脊柱畸形（CSD）患者在进行脊柱矫正和内固定之前，对脊髓分裂畸形（SCM）进行神经外科干预的必要性。
SCM 通常与 CSD 相关。随着对 SCM 病理的深入了解，人们普遍认为所有 SCM 都需要手术，然后才能进行任何矫形干预。
回顾性评估了 1994 年至 2005 年间接受脊柱矫正和后路内固定治疗的 61 例连续 CSD 伴脊柱发育不良患者。纳入标准为 CSD 伴 SCM 患者，行长节段内固定（超过 6 个功能单位），随访时间至少 2 年。32 例患者（8 例男性，24 例女性），平均年龄 11 岁+8 个月（4-18 岁），符合标准。所有 I 型 SCM 患者均在矫形手术前接受神经外科干预（骨棘切除和硬脊膜重建），而 II 型 SCM 患者则在不进行神经干预的情况下接受器械融合治疗。
18 例患者为 I 型 SCM，14 例患者为 II 型 SCM。平均随访时间为 52 个月（24-144 个月）。I 型 SCM 畸形矫正率为 44%，II 型 SCM 为 47%。2 例 II 型 SCM 患者出现短暂性神经功能恶化，而 II 型 SCM 患者无神经事件。
由于 SCM 发生率高，所有 CSD 患者在手术前都必须进行 MRI 检查。即使对于无神经症状的 I 型 SCM，也建议在脊柱畸形手术前进行神经外科干预；然而，对于 II 型 SCM 患者，可以安全地进行治疗，而无需神经外科干预。
