Journal article
Radiological and clinical predictors of scoliosis in patients with Chiari malformation type I and spinal cord syrinx from the Park-Reeves Syringomyelia Research Consortium
Journal of neurosurgery. Pediatrics, Vol.24(5), pp.520-527
11/2019
DOI: 10.3171/2019.5.PEDS18527
PMID: 31419800
Abstract
OBJECTIVEScoliosis is frequently a presenting sign of Chiari malformation type I (CM-I) with syrinx. The authors’ goal was to define scoliosis in this population and describe how radiological characteristics of CM-I and syrinx relate to the presence and severity of scoliosis.METHODSA large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°).RESULTSBased on available imaging of patients with CM-I and syrinx, 260 of 825 patients (31%) had a clear diagnosis of scoliosis based on radiographs or coronal MRI. Forty-nine patients (5.9%) did not have scoliosis, and in 516 (63%) patients, a clear determination of the presence or absence of scoliosis could not be made. Comparison of patients with and those without a definite scoliosis diagnosis indicated that scoliosis was associated with wider syrinxes (8.7 vs 6.3 mm, OR 1.25, p < 0.001), longer syrinxes (10.3 vs 6.2 levels, OR 1.18, p < 0.001), syrinxes with their rostral extent located in the cervical spine (94% vs 80%, OR 3.91, p = 0.001), and holocord syrinxes (50% vs 16%, OR 5.61, p < 0.001). Multivariable regression analysis revealed syrinx length and the presence of holocord syrinx to be independent predictors of scoliosis in this patient cohort. Scoliosis was not associated with sex, age at CM-I diagnosis, tonsil position, pB–C2 distance (measured perpendicular distance from the ventral dura to a line drawn from the basion to the posterior-inferior aspect of C2), clivoaxial angle, or frontal-occipital horn ratio. Average curve magnitude was 29.9°, and 37.7% of patients had a left thoracic curve. Older age at CM-I or syrinx diagnosis (p < 0.0001) was associated with greater curve magnitude whereas there was no association between syrinx dimensions and curve magnitude.CONCLUSIONSSyrinx characteristics, but not tonsil position, were related to the presence of scoliosis in patients with CM-I, and there was an independent association of syrinx length and holocord syrinx with scoliosis. Further study is needed to evaluate the nature of the relationship between syrinx and scoliosis in patients with CM-I.
Details
- Title: Subtitle
- Radiological and clinical predictors of scoliosis in patients with Chiari malformation type I and spinal cord syrinx from the Park-Reeves Syringomyelia Research Consortium
- Creators
- Jennifer M Strahle - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriRukayat Taiwo - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriChristine Averill - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriJames Torner - Department of Epidemiology, University of Iowa, Iowa City, IowaChevis N Shannon - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TennesseeChristopher M Bonfield - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TennesseeGerald F Tuite - Department of Neurosurgery, Neuroscience Institute, All Children’s Hospital, St. Petersburg, FloridaTammy Bethel-Anderson - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriJerrel Rutlin - Department of Radiology, Washington University School of Medicine, St. Louis, MissouriDouglas L Brockmeyer - Department of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, UtahJohn C Wellons - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TennesseeJeffrey R Leonard - Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OhioFrancesco T Mangano - Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioJames M Johnston - Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, AlabamaManish N Shah - Department of Pediatric Surgery and Neurosurgery, The University of Texas McGovern Medical School, Houston, TexasBermans J Iskandar - Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WisconsinElizabeth C Tyler-Kabara - Department of Neurosurgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PennsylvaniaDavid J Daniels - Department of Neurosurgery, The Mayo Clinic, Rochester, MinnesotaEric M Jackson - Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MarylandGerald A Grant - Department of Neurosurgery, Stanford Child Health Research Institute, Stanford, CaliforniaDaniel E Couture - Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North CarolinaP. David Adelson - Department of Neurosurgery, Barrow Neurological Institute, Phoenix, ArizonaTord D Alden - Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IllinoisPhilipp R Aldana - Department of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FloridaRichard C. E Anderson - Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, New York, New YorkNathan R Selden - Department of Neurological Surgery, Oregon Health & Science University, Portland, OregonLissa C Baird - Department of Neurological Surgery, Oregon Health & Science University, Portland, OregonKarin Bierbrauer - Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioJoshua J Chern - Department of Neurosurgery, Children’s Healthcare of Atlanta, GeorgiaWilliam E Whitehead - Department of Neurosurgery, Baylor College of Medicine, Houston, TexasRichard G Ellenbogen - Department of Neurosurgery, University of Washington Medicine, Seattle, WashingtonHerbert E Fuchs - Department of Neurosurgery, Duke University School of Medicine, Durham, North CarolinaDaniel J Guillaume - Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MinnesotaTodd C Hankinson - Department of Neurosurgery, Children’s Hospital Colorado, Aurora, ColoradoMark R Iantosca - Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaW. Jerry Oakes - Division of Neurosurgery, University of Alabama School of Medicine, Birmingham, AlabamaRobert F Keating - Department of Neurosurgery, Children’s National Medical Center, Washington, DCNickalus R Khan - Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TennesseeMichael S Muhlbauer - Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TennesseeJ. Gordon McComb - Division of Neurosurgery, Children’s Hospital Los Angeles, CaliforniaArnold H Menezes - Department of Neurosurgery, University of Iowa Hospitals, Iowa City, IowaJohn Ragheb - Department of Pediatric Neurosurgery, Miami Children’s Hospital and University of Miami Miller School of Medicine, Miami, FloridaJodi L Smith - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaCormac O Maher - Department of Neurosurgery, University of Michigan, Ann Arbor, MichiganStephanie Greene - Department of Neurosurgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PennsylvaniaMichael Kelly - Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MissouriBrent R O’Neill - Department of Neurosurgery, Children’s Hospital Colorado, Aurora, ColoradoMark D Krieger - Division of Neurosurgery, Children’s Hospital Los Angeles, CaliforniaMandeep Tamber - Department of Neurosurgery, The University of British Columbia, Vancouver, British Columbia, CanadaSusan R Durham - Department of Neurosurgery, University of Vermont College of Medicine, Burlington, VermontGreg Olavarria - Arnold Palmer Hospital for Children, Orlando, FloridaScellig S. D Stone - Department of Neurosurgery, Boston Children’s Hospital, Boston, MassachusettsBruce A Kaufman - Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WisconsinGregory G Heuer - Division of Neurosurgery, Children’s Hospital of Philadelphia, PennsylvaniaDavid F Bauer - Department of Neurosurgery, Dartmouth Geisel School of Medicine, Hanover, New HampshireGregory Albert - Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, ArkansasJeffrey P Greenfield - Department of Neurological Surgery, Weill Cornell Medical Center, New York, New YorkScott D Wait - Department of Neurological Surgery, Levine Children’s Hospital, Charlotte, North CarolinaMark D Van Poppel - Department of Neurological Surgery, Levine Children’s Hospital, Charlotte, North CarolinaRamin Eskandari - Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; andTimothy Mapstone - Department of Neurosurgery, Oklahoma University Medical Center, Oklahoma City, OklahomaJoshua S Shimony - Department of Radiology, Washington University School of Medicine, St. Louis, MissouriRalph G Dacey - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriMatthew D Smyth - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriTae Sung Park - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriDavid D Limbrick - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.24(5), pp.520-527
- DOI
- 10.3171/2019.5.PEDS18527
- PMID
- 31419800
- NLM abbreviation
- J Neurosurg Pediatr
- ISSN
- 1933-0707
- eISSN
- 1933-0715
- Language
- English
- Date published
- 11/2019
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984214834302771
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