Osteotomy Therapy And Efficacy In The Treatment Of Severe Rigid Kyphoscoliosis Associated With Chiari Malformation

Background It is difficult and high-risk of surgical treatment for severe and rigid ky-phoscoliosis associated with Chiari malformation (CM) while the domestic clinical re-search is currently insufficient.Objective To research the therapy of posterior vertebral column resection in severe and rigid kyphoscoliosis combined with CM and its early clinical efficacy.Methods Data of 17 patients, who had undergone surgical treatment for severe and rigid kyphoscoliosis associated with CM from February 2011 to February 2015 in our hospi-tal, were retrospectively analyzed.7 of these patients were males and 10 were females with an average age of 19.7±7.3 years (range 14-27years). Neurologic deficits syn-drome existed in 11 patients before operation. The pre-operation major coronal Cobb angle ranged from 88°to 135°(average 109.8°±21.6°). The kyphosis Cobb angle ranged from 80°to 128°(average 92.7°±11.9°). All the surgeries were operated in 2 stages.17 patients had undergone Posterior Fossa Decompression (PFD) at the first surgery. All patients had undergone the second surgery of Posterior Vertebral Column Resection (PVCR) in 2 weeks-2 months after the first surgery. The blood loss, the operation time and the imaging changes of pre-operation, post-operation (2 weeks later) and last fol-low-up were recorded.Results All the operations were successful. The average operation time was 369.5±102.1min (286-570 min) and the average blood loss was 2195.8±1092.4 ml (1700-4300 ml). All the patients were followed up for 8 months to 39 months (aver-age 14.7±3.5 months). There was no instrument failure and new neurologic deficits complications at final follow-up,. The post-operation (2 weeks later) major coronal Cobb angle was 46.2°±10.7° (range 25°-70°), the average correction rate was (54.3±11.5)%. The kyphosis Cobb angle was 45.7°±12.4° (range 38°-65°), the average correction rate was (52.6±12.8)%. The average coronal Cobb angle at final follow-up was 48.7°±11.3°(range 30°-82°), the average lost rate was (3.8±2.6)%. The average kyphosis Cobb angle was 47.9°±13.2°(range 40°-75°), the average lost rate was (5.7±3.4)%. There were significant differences between pre-operative and post-operative(2 weeks later) coronal Cobb angle, kyphosis Cobb angle (P<0.05);there were no significant differences between post-operation (2 weeks later) and last fol-low-up coronal Cobb angle, kyphosis Cobb angle (P>0.05)Conclusion Two-staged surgery is safe and effective for severe and rigid kyphoscoliosis associated with Chiari malformation.