Clinical features of split spinal cord malformations in congenital scoliosis of 69 surgical cases

English Keywords:Congenital scoliosis  Split spinal cord malformations  Surgery complication

English Abstract:

  【Abstract】 Objectives: To analyze clinical features, radiological findings and surgical outcomes of the patients with spine cord malformation(SCM) in congenital scoliosis(CS). Methods: A total of 69 patients with SCM was operated at our centre between March 2005 and March 2017. The mean age of the patients was 13.9 years and the female to male ratio was 1.46∶1. Patients′ demographic profile, radiological and operative details, complications and surgical outcomes were evaluated retrospectively. Results: Four patients had type ⅠSCM and 50 had type Ⅱ SCM. Fifteen patients had type Ⅰ and Ⅱ SCM concurrently. The dorsolumbar and lumbar regions were the most common sites for SCM. Asymmetric weakness of the lower limbs and neural axis abnormalities were presented in 10 cases. 37 patients had other intraspinal abnormalities(53.6%), including syringomyelia in 18(26.1%), tethered cord in 3(4.3%), low conus in 16(23.2%). 38 patients presented with lamina deformities(55.1%), 24 with hemivertebra(34.8%) and 25 with rib anomalies(36.2%). In total, the follow-up rate was 86.9%(60/69). The mean time of follow-up was 32.4±22.7 months(13-115 months). The average main curve, compensatory curve, thoracic kyphosis, lumbar lordosis, AVR, AVT and TS were 71.8°±29.4°，46.4°±17.3°, 39.5°±36.1°, 50.4°±17.3°, 2.1°±1.0°, 6.2±3.6cm and 2.8±3.0cm preoperatively, which improved to 28.8°±21.6°, 25.6°±14.5°, 25.5°±19.1°, 42.3°±15.4°, 1.9°±1.0°, 4.2±3.3cm and 2.4±2.8cm postoperatively. At the final follow-up, the average main curve, compensatory curve, thoracic kyphosis, lumbar lordosis, AVR, AVT and TS were 33.3°±25.9°, 27.1°±16.9°, 25.1°±16.1°, 45.6°±17.6°, 1.8°±0.9°, 4.9±6.0cm and 2.1±2.0cm. The correction rate of main curve was 59.9% and 53.3% at post-operation and follow-up period. Compared with the preoperative ones, there were significant difference in main curve, compensatory curve, AVT, thoracic kyphosis and lumbar lordosis at post-operation(P<0.01). Compared to the post-operation, there were no significant differences in terms of main curve, compensatory curve, AVT, AVR, TS, thoracic kyphosis and lumbar lordosis at the final follow-up(P>0.05). The complication rate in neural axis was 8.7%(6/69). The incidence of implants related complication was 4.3%(3/69), including 2 pedicle screw loose and 1 rod breakage. The patient with rod fracture was performed by the revision surgery. In view of no symptom, the patients with screw loose were observed at the follow-up period. Conclusions: The dorsolumbar and lumbar regions are the most common sites for SCM. Mixed type is the most common vertebral deformity. The incidence of rib anomaly is the highest in T5-T12 segments(middle and low thoracic region).