Assistant Professor Amrita Institute of Medical Sciences, Cochin, Kerala, India, Kerala, India
Introduction: 25%-85% of patients with syringomyelia have associated scoliosis. Historically, the risk of iatrogenic neurologic injury during scoliosis correction was considered higher with syringomyelia, prompting recommendations for prior neurosurgical treatment. However, recent evidence suggests that single-stage posterior scoliosis correction without pre-operative neurosurgical intervention can be effective. Despite this, there is limited literature and no consensus on the best treatment approach.
Methods: A systematic review following PRISMA guidelines was performed using the search phrase ((Syringomyelia OR Syrinx OR Chiari-1 Malformation) AND (Scoliosis Surgery)). Only English-language articles from January 2003 to December 2023 were included, excluding case reports and series < 15 patients.
Results: Ten articles met the criteria, analyzing 369 patients (171 males,198 females) with a mean age of 15.5 years and scoliosis associated with syringomyelia. The average follow-up was 40.4 months (range:24-82.5). Of the patients,58.7% had syringomyelia with Chiari-1 malformation, and 41.3% had idiopathic syringomyelia. The average syrinx length was 9.4 vertebrae(range 4.8-14). Pre-existing sensory deficits were present in 5.8% and motor deficits in 4.1% of patients. Prior neurosurgical procedures were performed in only 38.2% of patients(32.7% foramen magnum decompression;5.5% syrinx shunting). The mean pre-operative Cobb angle was 63.2°, improving to 20.5° post-operatively, with a correction rate of 67.9%. Thoracic kyphosis decreased from 38.4° to29.6°. Neurological complications occurred in 1.4% of patients. Other complications include surgical site infections (0.5%), screw malposition (2.4%), and junctional problems (1.3%).
Conclusion : Surgical correction of scoliosis with syringomyelia is generally safe and effective. Single-stage posterior scoliosis correction can be performed without prior neurosurgical decompression in carefully selected patients.