Feng Fan, Shen Jianxiong, Zhang Jianguo, Li Shugang, Yu Keyi, Tan Haining
1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, People's Republic of China.
J Bone Joint Surg Am. 2016 Dec 21;98(24):2096-2102. doi: 10.2106/JBJS.16.00414.
The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making.
Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B).
There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030).
The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis. An osseous spur at the apex of the scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
脊髓纵裂畸形（SCM）的自然病史仍不清楚。了解骨嵴的特征及其与脊柱畸形的关系，可能有助于早期识别神经功能缺损风险较高的患者，并改善手术决策。
回顾性分析2000年5月至2013年12月在我院接受手术治疗的85例先天性脊柱侧弯合并I型SCM患者。其中男性22例，女性63例，手术时平均年龄13.9岁。收集术前临床和影像学资料，以研究脊柱侧弯和骨嵴的特征。根据患者神经功能是否完整分为两组（A组）或存在神经功能缺损（B组）。
A组（神经功能完整）52例（61%），B组（神经功能缺损）33例（39%）。两组在人口统计学分布、侧弯程度、骨嵴长度和厚度方面无显著差异。在A组中，骨嵴相对于主弯顶点的位置，近端13例（25%），远端28例（54%），中央11例（21%）。在B组中，骨嵴近端7例（21%），远端8例（24%），中央18例（55%）。两组在骨嵴位置上有显著差异（卡方 = 10.898，p = 0.004）。B组患者脊柱后凸畸形的比例（42%）高于A组（10%）。两组半脊髓直径之比（凹侧除以凸侧）有显著差异（A组为0.98，B组为0.89，p = 0.030）。
先天性脊柱侧弯合并I型SCM患者的神经状态似乎与骨嵴相对于先天性脊柱侧弯的位置密切相关。脊柱侧弯顶点处的骨嵴可能与神经功能缺损风险较高有关，尤其是在合并脊柱后凸畸形的患者中。脊髓的不对称分裂可能导致神经功能缺损。
预后III级。有关证据水平的完整描述，请参阅作者指南。
