Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities?

Spine (Phila Pa 1976). 2009 Oct 15;34(22):2413-8. doi: 10.1097/BRS.0b013e3181b9c61b.

Abstract

Study design: Retrospective case series.

Objectives: To evaluate the necessity of neurosurgical interventions for split cord malformations (SCMs) before correction and instrumentation for patients with congenital spinal deformity(CSD)s.

Summary of background data: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Evaluation Study

MeSH terms

  • Abnormalities, Multiple / surgery
  • Adolescent
  • Child
  • Child, Preschool
  • Disability Evaluation
  • Female
  • Humans
  • Incidence
  • Laminectomy / methods
  • Laminectomy / standards
  • Male
  • Nervous System Malformations / complications
  • Nervous System Malformations / pathology
  • Nervous System Malformations / surgery
  • Neurosurgical Procedures / methods
  • Neurosurgical Procedures / standards*
  • Outcome Assessment, Health Care
  • Reconstructive Surgical Procedures / methods
  • Reconstructive Surgical Procedures / standards
  • Retrospective Studies
  • Severity of Illness Index
  • Spinal Cord / abnormalities*
  • Spinal Cord / surgery*
  • Spinal Dysraphism / complications*
  • Spinal Dysraphism / pathology
  • Spinal Dysraphism / surgery*
  • Spinal Fusion / methods
  • Spinal Fusion / standards
  • Syndrome