Treatment Of Congenital Spinal Deformity With Split Spinal Cord Malformation

Part I: Safety and Efficacy of One-Stage Surgical Treatment for CongenitalSpinal Deformity with Split Spinal Cord MalformationIntroduction: Correction of progressive CSD with SSCM has beenreported that all SSCM should be operated firstly before any orthopedicintervention and then the second surgery for correction and stabilization of thespinal deformity3to6months later. Recently, more different viewpoints havebeen approved. The common belief of treatment for these2associatedconditions is needed to be revised.Objective: To retrospectively evaluate the safety and efficacy of one-stagesurgical treatment for progressive CSD with split spinal cord malformation(SSCM).Materials and Methods: The records of38patients (30female,8male)with split spinal cord malformation (SSCM) were reviewed, who were treated byone stage surgery. The surgery procedure of all the patients was arranged in posterior approaches. In Type I SSCM patients, after exposure of the determinedlevels and placement of instruments, bony spur was resected. Then a correctivesurgery and a posterior fusion surgery were performed simultaneously. In Type IISSCM patients, as their spinal cord is normal, the corrective surgery wasperformed directely. Changes of major coronal curve, balance of spine andpatterns of curve were measured, and complication, levels of instruments,neurological status pre and postoperative were recorded.Results: The mean age of the patients was14.9years and the meanfollow-up period was31months. There were13Type I SSCM patients and25Type II patients. Five of them had progressive neurologic deteriorationspreoperatively. The mean major curves were corrected from an average of70.9oto30.6owith a correction rate of57.0%. The overall complication was transient,including2patients of neurological compromise and1patient of cerebrospinalfluid leakage. The average loss of correction at final follow-up was2.0oforcoronal major curves.Conclusion: The one-stage surgical treatment for CSD associated withSSCM provides a satisfactory option to effectively improve the spinal deformitywithout significant complications. Neurosurgical intervention is recommendedto patients with Type I SSCM before corrective surgery of spinal deformity;however, patients with Type II SSCM can be treated safely without a need ofneurosurgical intervention.Part II Non-Fusion and Growing Instrumentation in the correction ofCongenital Spinal Deformity Associated with Split Spinal CordMalformation–an Early Follow-up Outcomes Introduction: Children of CSD with SSCM may inevitably have scoliosisprogression and neurological deterioration. Although the traditional stagingoperation has a certain effect, the complications such as TIS, short trunk and etc.appear in most cases. It seems that there is no satisfactory treatment until now.And it would be a breakthrough if non-fusion and growing instrumentationcould achieve desired efficacy as well as stop progressive neurologicaldeterioration.Study Design: A retrospective case review.Objective: To evaluate the safety and efficacy of the non-fusion techniquein achieving and maintaining CSD correction while allowing normal spinalgrowth in patients with SSCM.Materials and Methods:7children of CSD associalted with SSCN wereadopted, with a mean age of8years. All the patients in this study receivedHalo-gravity traction (HGT) prior to expansion of the spine with a verticalexpandable titanium prosthetic rib, growing rod or hybrid at an interval of sixmonths. Two of them underwent bony spur excision before correctivemanipulation, while five of them underwent opening wedge thoracoplasty. Thenall the patients received a lengthened operation every six months. Changes of theirmajor curve and length of T1-S1spine were measured, and complications,neurological status were recorded. All the patients were followed up with anaverage of32.6months.Results: Their mean major curve improved from90.0degrees to59.4degrees with a correction rate of36.4%. The T1–S1length increased from26.3cm (range,22.0–30.2cm) to34.7cm (range,29.6–37.3cm) at finalfollow-up. Especially, one of the two type I SSCM patients who were found neurological deterioration before surgery, significantly improved after receivingbony spur excision and duraplasty.Conclusions: Preoperative Halo-gravity traction followed by non-fusionand growing instrumentation is effective for CSD associated with SSCM.