I型Chiari畸形伴脊髓空洞症的硬脑膜外减压术与硬脑膜成形术：来自帕克-里夫斯脊髓空洞症研究联盟的脊柱侧弯治疗结果
Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium.
作者信息
Sadler Brooke, Skidmore Alex, Gewirtz Jordan, Anderson Richard C E, Haller Gabe, Ackerman Laurie L, Adelson P David, Ahmed Raheel, Albert Gregory W, Aldana Philipp R, Alden Tord D, Averill Christine, Baird Lissa C, Bauer David F, Bethel-Anderson Tammy, Bierbrauer Karin S, Bonfield Christopher M, Brockmeyer Douglas L, Chern Joshua J, Couture Daniel E, Daniels David J, Dlouhy Brian J, Durham Susan R, Ellenbogen Richard G, Eskandari Ramin, Fuchs Herbert E, George Timothy M, Grant Gerald A, Graupman Patrick C, Greene Stephanie, Greenfield Jeffrey P, Gross Naina L, Guillaume Daniel J, Hankinson Todd C, Heuer Gregory G, Iantosca Mark, Iskandar Bermans J, Jackson Eric M, Jea Andrew H, Johnston James M, Keating Robert F, Khan Nickalus, Krieger Mark D, Leonard Jeffrey R, Maher Cormac O, Mangano Francesco T, Mapstone Timothy B, McComb J Gordon, McEvoy Sean D, Meehan Thanda, Menezes Arnold H, Muhlbauer Michael, Oakes W Jerry, Olavarria Greg, O'Neill Brent R, Ragheb John, Selden Nathan R, Shah Manish N, Shannon Chevis N, Smith Jodi, Smyth Matthew D, Stone Scellig S D, Tuite Gerald F, Wait Scott D, Wellons John C, Whitehead William E, Park Tae Sung, Limbrick David D, Strahle Jennifer M
机构信息
1Department of Pediatrics, Washington University in St. Louis, MO.
2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.
出版信息
J Neurosurg Pediatr. 2021 Jun 18;28(2):167-175. doi: 10.3171/2020.12.PEDS20552. Print 2021 Aug 1.
OBJECTIVE
Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression.
METHODS
A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty.
RESULTS
In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion.
CONCLUSIONS
In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.
目的
脊柱侧凸在I型Chiari畸形（CM-I）相关的脊髓空洞症患者中很常见。虽然已知后颅窝减压术（PFD）治疗可能会减少脊柱侧凸的进展，但硬膜成形减压术是否优于硬脊膜外减压术尚不清楚。
方法
对1257例患有CM-I（扁桃体位于枕大孔下方≥5mm）和脊髓空洞症（轴向宽度≥3mm）的儿科患者进行了一项大型多中心回顾性和前瞻性登记研究，以评估接受或未接受硬膜成形术的PFD脊柱侧凸患者。
结果
共有422例接受PFD的患者临床诊断为脊柱侧凸。在这些患者中，346例行硬膜成形术，51例仅接受硬脊膜外减压，25例因无PFD类型的数据而被排除。平均临床随访时间为2.6年。总体而言，接受和未接受硬膜成形术的患者在随后的融合发生率或曲线进展患者比例方面没有差异。然而，在控制年龄、性别、术前曲线大小、脊髓空洞长度、脊髓空洞宽度和全脊髓空洞症后，硬脊膜外减压与曲线进展>10°相关，但与融合发生率增加无关。PFD时年龄较大和术前曲线大小较大与随后的融合发生独立相关。两种类型的PFD后脊髓空洞缩小程度更大与融合发生率降低相关。
结论
在接受PFD的CM-I、脊髓空洞症和脊柱侧凸患者中，接受硬膜成形术和硬脊膜外减压术的患者在脊柱侧凸手术矫正的后续发生率上没有差异。然而，在控制包括年龄、脊髓空洞特征和曲线大小等术前因素后，接受硬膜成形术治疗的患者比接受硬脊膜外减压术治疗的患者曲线进展的可能性更小。需要进一步研究来评估硬膜成形术在PFD后曲线稳定中的作用。
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