Divisions of 1 Paediatric Neurosurgery and.
Spine Surgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala.
Neurosurg Focus. 2017 Oct;43(4):E13. doi: 10.3171/2017.7.FOCUS17348.
OBJECTIVE Neurogenic kyphoscoliosis in pediatric patients has varied causes and diverse management options. The most common management strategy is to stage the orthopedic and neurosurgical aspects of the correction at an interval of 3-6 months from each other. The aim of this study was to report the authors' experience with correction of deformity in children with associated neurological abnormalities requiring intervention as a single-stage surgical treatment. METHODS Of 591 pediatric patients with scoliosis treated at the Amrita Institute of Medical Sciences and Research Centre between January 2001 and January 2011, the authors identified all patients with neurogenic kyphoscoliosis who underwent deformity correction and a neurosurgical procedure in the same surgical session when they were younger than 15 years. Data regarding the demographic details, preoperative Cobb angle/kyphotic angle, surgical details, postoperative complications, cost of the procedure, and long-term neurological outcome were collected for each case and analyzed. Based on the results of this analysis, the authors propose a 2-category risk stratification system for the timing of deformity correction depending on the primary neurogenic etiology. RESULTS Ten cases involving patients with neurogenic kyphoscoliosis requiring both deformity correction and neurosurgical procedure met the criteria and were included in the analysis. All 10 patients were younger than 15 years; their mean age was 10.8 years. The average Cobb angle was 59.5°. Five patients underwent foramen magnum decompression, 5 patients underwent spinal cord detethering, and 1 patient had intraspinal intradural tumor excision. The mean estimated blood loss was 1177 ml (range 700-1550 ml), and the mean operative time was 4.4 hours (range 3-5.5 hours). There were no intraoperative complications. None of the patients had any new postoperative neurological deficits. The mean postoperative Cobb angle of the main thoracic curve was 12.6°. CONCLUSIONS Simultaneous deformity correction along with a definitive neurosurgical procedure in patients with neurogenic kyphoscoliosis can be performed without added morbidity and avoids both the added costs and the risk of complications associated with a second surgery. The risk stratification system proposed in this paper may serve as a guideline for case selection and help to optimize outcome.
小儿神经源性脊柱侧后凸畸形的病因多样，治疗方法各异。最常见的治疗策略是将矫形和神经外科方面的治疗分开，间隔 3-6 个月进行。本研究旨在报告作者对伴有神经功能障碍的儿童进行单一阶段手术治疗的经验，包括畸形矫正和神经外科干预。
在 2001 年 1 月至 2011 年 1 月期间，在 Amrita 医学科学研究所和研究中心治疗的 591 例小儿脊柱侧凸患者中，作者确定了所有在 15 岁以下接受神经源性脊柱侧后凸畸形矫正和神经外科手术的患者。收集了每个病例的人口统计学细节、术前 Cobb 角/后凸角、手术细节、术后并发症、手术费用和长期神经功能预后等数据，并进行了分析。根据分析结果，作者提出了一种基于主要神经源性病因的 2 类风险分层系统，用于确定畸形矫正的时机。
符合条件并纳入分析的 10 例神经源性脊柱侧后凸畸形患者均需要进行畸形矫正和神经外科手术。10 例患者均小于 15 岁，平均年龄为 10.8 岁。平均 Cobb 角为 59.5°。5 例患者行枕骨大孔减压术，5 例患者行脊髓松解术，1 例患者行脊髓内椎管内肿瘤切除术。平均估计失血量为 1177ml（范围 700-1550ml），平均手术时间为 4.4 小时（范围 3-5.5 小时）。术中无并发症。无患者出现新的术后神经功能缺损。主胸段脊柱侧凸的平均术后 Cobb 角为 12.6°。
在神经源性脊柱侧后凸畸形患者中，同时进行畸形矫正和确定性神经外科手术可以在不增加发病率的情况下进行，避免了二次手术的额外费用和并发症风险。本研究提出的风险分层系统可以作为病例选择的指南，有助于优化治疗效果。
