Safety and efficacy of 2-staged surgery for congenital scoliosis combined with split spinal cord malformation and tethered cord

English Keywords:Congenital scoliosis  Split spinal cord malformation  Tethered cord  Surgery

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and short term outcome of 2-staged surgery for congenital scoliosis combined with split spinal cord malformation(SSCM) and tethered cord. Methods: Data of 66 patients, who had undergone surgical treatment for congenital scoliosis combined with SSCM and tethered cord from January 2009 to January 2014 in our hospital， were retrospectively analyzed． 20 of these patients were males and 46 were females with an average age of 17.2±4.5 years(range, 7-26 years)． The mean major coronal Cobb angle ranged from 50° to 165°(average, 97.6°±23.5°). 23 patients were also accompanied by kyphosis with the Cobb angle ranging from 47° to 165°(average, 89.5°±13.9°). There were 45 patients with type Ⅰ SSCM and 21 patients with type Ⅱ SSCM, all patients were combined with tethered cord. All the surgeries were operated in 2 stages. At the first surgery, bony spur was resected and tetherd cord was released for the patient with type Ⅰ SSCM, and only tetherd cord was released for the patient with type Ⅱ SSCM. 3-4 weeks after the first surgery, the scoliosis was corrected. Results: All the patients were followed up for 6 months to 24 months(average, 12.4±3.5 months). The average operation time was 208.7±107.2min(range, 60-505min) and the average blood loss was 297.1±192.6ml(range, 20-2000ml) for the first surgery. The average operation time was 392.6±150.7min(range, 196-600min) and the average blood loss was 2158.8±1158.4ml(range, 450-6000ml) for the second surgery. There were 2 patients(3.0%, 2/66) experiencing neurological deterioration at the second surgery, 4 patients(6.1%, 4/66) had pleural effusion after the second surgery and no patient presented infection. There was no instrument failure at final follow-up. The average coronal Cobb angle after surgery was 41.6°±17.8°(range, 12°-107°), the average correction rate was (61.3±14.3)%. The average coronal Cobb angle at final follow-up was 43.7°±16.6°(range, 15°-108°), the average lost rate was （1.9±1.1）%. The average kyphosis Cobb angle after surgery was 38.4°±11.0°(range, 2°-78°), the average correction rate was (67.6±23.4)%. The average kyphosis Cobb angle at final follow-up was 39.7°±11.2°(range, 3°-87°), the average lost rate was (2.3±1.3)%. Conclusions: Two-staged surgery is safe and effective for congenital scoliosis combined with SSCM and tethered cord.