Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina.
Spine Deform. 2021 Sep;9(5):1253-1258. doi: 10.1007/s43390-021-00336-0. Epub 2021 Apr 1.
The association between Chiari 1 malformation and scoliosis is well known in the literature. Prevalence has increased after the advent of magnetic resonance imaging. In children with this association, prophylactic suboccipital decompression prior to scoliosis correction is a common surgical procedure although the rationale for this surgical management and whether not performing it may lead to spinal cord injury has not been clearly elucidated. We conducted a systematic review of the literature with the aim to obtain strong data to support the hypothesis that it is safe to proceed with scoliosis correction without prior prophylactic suboccipital decompression for Chiari 1 in an asymptomatic population. Using the Prisma methodology, we analyzed 3250 studies published between 1972 and 2018. Only four studies met the inclusion criteria. None of the studies had a level of evidence high enough to recommend prophylactic decompression previous to correction of the spinal deformity.
Chiari 1 畸形与脊柱侧凸的相关性在文献中已有充分的记载。磁共振成像问世后，其发病率有所增加。对于存在这种关联的患儿，在脊柱侧凸矫正前预防性行颅后窝减压术是一种常见的手术方法，但这种手术管理的基本原理以及不进行手术是否会导致脊髓损伤尚未明确阐明。我们对文献进行了系统回顾，旨在获得有力的数据来支持这样一种假设，即在无症状人群中，Chiari 1 患者无需行预防性颅后窝减压术即可安全地进行脊柱侧凸矫正。我们使用 Prisma 方法，分析了 1972 年至 2018 年期间发表的 3250 项研究。只有四项研究符合纳入标准。没有一项研究的证据级别高到足以推荐在矫正脊柱畸形之前进行预防性减压。
