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Effect of Posterior Fossa Decompression for Chiari Malformation-I on Scoliosis
Silky Chotai1, Jade Basem, Stephen Gannon
1Division of Pediatric Neurosurgery, Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Posterior fossa decompression (PFD) for Chiari malformation-I (CM-I) showed varied effects on scoliosis. While some patients experienced improvement, many with adolescent-onset or severe curves required corrective surgery post-PFD.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pediatric Neurology
Background:
- Scoliosis frequently co-occurs with Chiari malformation-I (CM-I).
- The impact of posterior fossa decompression (PFD) on scoliosis severity in CM-I patients is not fully understood.
Purpose of the Study:
- To evaluate changes in scoliosis severity following PFD in pediatric patients with CM-I.
- To identify factors influencing scoliosis progression or improvement after PFD.
Main Methods:
- Retrospective review of pediatric patients with CM-I and untreated scoliosis who underwent PFD.
- Analysis of 17 patients with complete follow-up data and imaging.
Main Results:
- Scoliosis improved in 41.2%, worsened in 52.9%, and remained stable in 5.9% of patients post-PFD.
- Adolescent-onset scoliosis (78%) and preoperative curves ≥35 degrees (82%) were significantly associated with the need for corrective surgery after PFD (p = 0.018).
Conclusions:
- PFD may lead to scoliosis improvement or stabilization in select CM-I patients.
- Scoliosis management in CM-I patients requires careful consideration of onset and curve severity, particularly after PFD.
Background/Aims:
Scoliosis is common in patients with Chiari malformation-I (CM-I). This study examined the change in scoliosis severity after posterior fossa decompression (PFD) for CM-I.
Methods:
We conducted a retrospective review at a single tertiary center for children undergoing PFD with untreated scoliosis, and identified 17 patients with complete follow-up data and imaging.
Results:
Overall, scoliosis improved in 7 (41.2%) patients, worsened in 9 (52.9%), and remained unchanged in 1 (5.9%) after PFD (mean follow-up of 7.8 ± 4.1 months). We found that 3 of the 8 (38%) children with early-onset scoliosis eventually needed scoliosis corrective surgery, which was needed in 7 of the 9 (78%) patients with adolescent-onset scoliosis. In addition, only 1 patient (17%) with a preoperative scoliosis curve <35 degrees and 9 patients (82%) with a curve ≥35 degrees required surgery for scoliosis correction despite PFD (p = 0.018).
Conclusion:
In certain patients, PFD for CM-I may lead to improvement or stabilization of scoliosis.
