Abstract
BackgroundScoliosis patients with associated syringomyelia are at an increased risk of neurological injury during surgical deformity correction. The syrinx is therefore often addressed surgically prior to scoliosis correction to minimize this risk. It remains unclear if the presence of a persistent central canal (PCC) within the spinal cord also poses a similar risk. The aim of this study is to determine whether there is any evidence to suggest that patients with a PCC are also at a higher risk of neurological injury during surgical scoliosis correction.MethodsEleven patients with a PCC identified on pre-operative magnetic resonance imaging who had undergone correction of adolescent idiopathic scoliosis (AIS) over a 7-year study period at our institution were retrospectively identified. The incidence of abnormal intra-operative spinal cord monitoring (SCM) traces in this group was in turn compared against 44 randomly selected age- and sex-matched controls with no PCC who had also undergone surgical correction of AIS during the study period. Fisher’s exact test was applied to determine whether there was a significant difference in the incidence of abnormal intra-operative SCM traces between the two groups.ResultsStatistical analysis demonstrated no significant difference in the incidence of abnormal intra-operative SCM signal traces between the PCC group and the control group.ConclusionsThis study demonstrates no evidence to suggest a PCC increases the risk of neurological complications during scoliosis correction. We therefore suggest that surgical correction of scoliosis in patients with a PCC can be carried out safely with routine precautions.
Highlights
Scoliosis patients with associated syringomyelia are at an increased risk of neurological injury during surgical deformity correction
Previous studies have demonstrated patients with spinal cord pathology undergoing surgical correction of scoliosis are at an increased risk of sustaining intraoperative iatrogenic neurological injury [1, 7,8,9]
In order to test this hypothesis, all patients who had undergone surgical correction of adolescent idiopathic scoliosis (AIS) over a 7-year period between June 2004 and October 2011 at our institution who had a co-existing persistent central canal (PCC) confirmed with routine pre-operative whole spine magnetic resonance imaging (MRI) were retrospectively identified using an electronic database and were included in the study
Summary
Scoliosis patients with associated syringomyelia are at an increased risk of neurological injury during surgical deformity correction. The syrinx is often addressed surgically prior to scoliosis correction to minimize this risk It remains unclear if the presence of a persistent central canal (PCC) within the spinal cord poses a similar risk. The aim of this study is to determine whether there is any evidence to suggest that patients with a PCC are at a higher risk of neurological injury during surgical scoliosis correction. Previous studies have demonstrated patients with spinal cord pathology undergoing surgical correction of scoliosis are at an increased risk of sustaining intraoperative iatrogenic neurological injury [1, 7,8,9]. To the authors’ knowledge, there has not been a published study addressing the question as to whether the presence of a persistent central canal (PCC) poses an increased risk of intra-operative neurological injury during surgical correction of scoliosis.
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