Selective thoracic fusion for adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

Abstract

Purpose The aim of this study was to compare the clinical outcomes of selective thoracic fusion in the surgical treatment of Chiari malformation type I (CMI) adolescents with different curve patterns. Methods Sixty-three CMI patients with left thoracic curve (LTC) and 63 age-and curve-magnitude-matched CMI patients with right thoracic curve (RTC) were recruited. Selective thoracic fusion was performed for two groups. The coronal and sagittal parameters including the thoracic and lumbar Cobb angle, apical vertebral translation, trunk shift, thoracic kyphosis (TK), lumbar lordosis and sagittal vertical axis were measured before surgery, immediately postoperative and at the final follow-up. The accuracy of pedicle screw placement between both groups was also compared. Results All preoperative radiographic parameters were matched in both groups except for TK (LTC group 40.1° vs. RTC group 23.0°, P = 0.021). The immediately postoperative spontaneous correction of the lumbar curve was 56.9% in LTC group, which was remarkably lower than in RTC patients (67.9%). Patients with LTC were found to have obviously increased trunk shift than those with RTC (15.1 mm vs. 8.0 mm, P = 0.038). At the final follow-up, the correction of the thoracic curve was comparable between the two groups (59.9% vs. 62.6%, P = 0.610). The rate of the pedicle screw perforations was similar between both groups. Conclusions Patients with LTC and RTC can both be successfully corrected through selective thoracic fusion with a promising long-term surgical outcome. CMI patients with RTC tend to have a better spontaneous correction of the lumbar curve after surgery.

Selective thoracolumbar/lumbar fusion for Syringomyelia-associated scoliosis: a case-control study with Lenke 5C adolescent idiopathic scoliosis

“…Selective fusion has gained popularity over decades [8][9][10]. In recent studies, posterior selective thoracic fusion has been proven to produce a satisfying surgical outcome in syringomyelia patients with major thoracic curve [11][12][13]. However, to the best of our knowledge, no study has specifically focused on the thoracolumbar/lumbar curve in patients with syringomyelia-associated scoliosis.…”