The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary?

Abstract

Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group=16.6±3.6: 20.1±3.9, P=.01) and corrective rate (SSCM group: control group=50%: 58%, P=.046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.