Clinical Research Of Congenital Scoliosis Associated With Intraspinal Mass

BackgroundCongenital scoliosis is the most common congenital spinal deformity.Congenital scoliosis is caused by the abnormal vertebral development in the first eight embryonic.During this time,the bone component of the spine is formed.Neuraxis completed the inner flap and the central tube closed.These process are close connected,so congenital scoliosis are usually associated with intraspinal malformation,such as ththered cord,diastematomyelia and intraspinal mass.Intraspinal mass include the primary and the secondary.The formal is the primal mass within the spinal canal;the latter refers to the intraspinal mass comes from the adjacent tissue or the distant part.The intraspinal type of the congenital scoliosis often associated are congenital cystic masss.No study has illustrated the clinical analysis of congenital scoliosis associated intraspinal mass so far.ObjectiveTo analysis the clinical characteristics of congenital scoliosis associated with intraspinal mass and investigate the incidence,clinical manifestations,imaging characteristics and this retrospective study was designed to evaluate the safety andeffectiveness of one-stage correction of congenital scoliosis patients with intraspinal mass with a minimum 2-year-follow-up at a single Chinese center.MethodsThe clinical data of congenital scoliosis associated with intraspinal mass patients who underwent surgical operations from January 2007 to June 2016 in the Department of orthopedics,Xijing Hospital were retrospectively reviewed.Seven cases of congenital scoliosis associated with intraspinal mass,including 5 male and 2 female patients with the average age of 19.14±7.52 years(range 11-31 years).Lower extremity weakness were present in 3 cases.Lower extremity pain and numbness was present in one case.Scoliosis were present in 3 cases.MRI showed all of the intraspinal mass were located at the thoracic segment.Five of the intraspinal masses were intramedullary,one was intradural extramedullary and the last one was both of the intramedullary and intradural extramedullary.All of the patients were treated with one-stage intraspinal mass resection and scoliosis correction.Postoperative,we gave the patients antibiotics,neurotrophic and other supportive treatments.Clinical evaluation includes scoliosis correction rate,complications and recurrence rate.ResultsAll patients performed MRI examination before operation and pathological examination postoperative.Four cases consistent with pathological examination.All of the patients underwent the surgery of one-stage scoliosis correction and intraspinal mass resection.The average period of postoperative follow-up process was 49.71 ± 32.90months(range 27? 99 months).Average operating time was 550 ± 166 min(range,370–855 min),and average blood loss was 2100 ± 663 mL(range,1500–3000 mL).Postoperative pathologic examination revealed epidermoid cyst in 2 patients,dermoid cyst in 1,bronchogenic cyst in 1,teratoma in 2,and pilomyxoid astrocytoma in 1.All intraspinal masses were located at the thoracic segment.Five intraspinal masses were intramedullary,1 was intradural extramedullary,and 1 was both intramedullary and intradural extramedullary.One case was recurred at the 5 years follow-up,and the intraspinal mass didn't recur of 3 years follow-up after the secondsurgery.One patient has temporary muscle strength decrease postoperative and completely back to normal six months after surgery.And there was one patient had cerebrospinal fluid leakage.ConclusionThe incidence of congenital scoliosis associated with intraspinal mass is low.Diagnosis mainly depends on MRI and pathological examination.These patients who underwent single-stage surgery for CS associated with intraspinal mass had significant curvature correction without major complications.Based on our results,we can conclude that simultaneous intraspinal mass resection and scoliosis correction appears to be safe and effective.