Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium

Brooke Sadler; Alex Skidmore; Jordan Gewirtz; Richard C.E. Anderson; Gabe Haller; Laurie L. Ackerman; P. David Adelson; Raheel Ahmed; Gregory W. Albert; Philipp R. Aldana; Tord D. Alden; Christine Averill; Lissa C. Baird; David F. Bauer; Tammy Bethel-Anderson; Karin S. Bierbrauer; Christopher M. Bonfield; Douglas L. Brockmeyer; Joshua J. Chern; Daniel E. Couture; David J. Daniels; Brian J. Dlouhy; Susan R. Durham; Richard G. Ellenbogen; Ramin Eskandari; Herbert E. Fuchs; Timothy M. George; Gerald A. Grant; Patrick C. Graupman; Stephanie Greene; Jeffrey P. Greenfield; Naina L. Gross; Daniel J. Guillaume; Todd C. Hankinson; Gregory G. Heuer; Mark Iantosca; Bermans J. Iskandar; Eric M. Jackson; Andrew H. Jea; James M. Johnston; Robert F. Keating; Nickalus Khan; Mark D. Krieger; Jeffrey R. Leonard; Cormac O. Maher; Francesco T. Mangano; Timothy B. Mapstone; J. Gordon McComb; Sean D. McEvoy; Thanda Meehan; Arnold H. Menezes; Michael Muhlbauer; W. Jerry Oakes; Greg Olavarria; Brent R. O'Neill; John Ragheb; Nathan R. Selden; Manish N. Shah; Chevis N. Shannon; Jodi Smith; Matthew D. Smyth; Scellig S.D. Stone; Gerald F. Tuite; Scott D. Wait; John C. Wellons; William E. Whitehead; Tae Sung Park; David D. Limbrick; Jennifer M. Strahle

doi:10.3171/2020.12.PEDS20552

Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium

Brooke Sadler, Alex Skidmore, Jordan Gewirtz, Richard C.E. Anderson, Gabe Haller, Laurie L. Ackerman, P. David Adelson, Raheel Ahmed, Gregory W. Albert, Philipp R. Aldana, Tord D. Alden, Christine Averill, Lissa C. Baird, David F. Bauer, Tammy Bethel-Anderson, Karin S. Bierbrauer, Christopher M. Bonfield, Douglas L. Brockmeyer, Joshua J. Chern, Daniel E. CoutureDavid J. Daniels, Brian J. Dlouhy, Susan R. Durham, Richard G. Ellenbogen, Ramin Eskandari, Herbert E. Fuchs, Timothy M. George, Gerald A. Grant, Patrick C. Graupman, Stephanie Greene, Jeffrey P. Greenfield, Naina L. Gross, Daniel J. Guillaume, Todd C. Hankinson, Gregory G. Heuer, Mark Iantosca, Bermans J. Iskandar, Eric M. Jackson, Andrew H. Jea, James M. Johnston, Robert F. Keating, Nickalus Khan, Mark D. Krieger, Jeffrey R. Leonard, Cormac O. Maher, Francesco T. Mangano, Timothy B. Mapstone, J. Gordon McComb, Sean D. McEvoy, Thanda Meehan, Arnold H. Menezes, Michael Muhlbauer, W. Jerry Oakes, Greg Olavarria, Brent R. O'Neill, John Ragheb, Nathan R. Selden, Manish N. Shah, Chevis N. Shannon, Jodi Smith, Matthew D. Smyth, Scellig S.D. Stone, Gerald F. Tuite, Scott D. Wait, John C. Wellons, William E. Whitehead, Tae Sung Park, David D. Limbrick, Jennifer M. Strahle

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

OBJECTIVE Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.

Original language	English (US)
Pages (from-to)	167-175
Number of pages	9
Journal	Journal of Neurosurgery: Pediatrics
Volume	28
Issue number	2
DOIs	https://doi.org/10.3171/2020.12.PEDS20552
State	Published - Aug 2021

Keywords

Chiari I malformation
Posterior fossa decompression
Scoliosis
Spine
Syringomyelia

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health
Clinical Neurology

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10.3171/2020.12.PEDS20552

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Sadler, B., Skidmore, A., Gewirtz, J., Anderson, R. C. E., Haller, G., Ackerman, L. L., Adelson, P. D., Ahmed, R., Albert, G. W., Aldana, P. R., Alden, T. D., Averill, C., Baird, L. C., Bauer, D. F., Bethel-Anderson, T., Bierbrauer, K. S., Bonfield, C. M., Brockmeyer, D. L., Chern, J. J., ... Strahle, J. M. (2021). Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium. Journal of Neurosurgery: Pediatrics, 28(2), 167-175. https://doi.org/10.3171/2020.12.PEDS20552

Sadler, B, Skidmore, A, Gewirtz, J, Anderson, RCE, Haller, G, Ackerman, LL, Adelson, PD, Ahmed, R, Albert, GW, Aldana, PR, Alden, TD, Averill, C, Baird, LC, Bauer, DF, Bethel-Anderson, T, Bierbrauer, KS, Bonfield, CM, Brockmeyer, DL, Chern, JJ, Couture, DE, Daniels, DJ, Dlouhy, BJ, Durham, SR, Ellenbogen, RG, Eskandari, R, Fuchs, HE, George, TM, Grant, GA, Graupman, PC, Greene, S, Greenfield, JP, Gross, NL, Guillaume, DJ, Hankinson, TC, Heuer, GG, Iantosca, M, Iskandar, BJ, Jackson, EM, Jea, AH, Johnston, JM, Keating, RF, Khan, N, Krieger, MD, Leonard, JR, Maher, CO, Mangano, FT, Mapstone, TB, McComb, JG, McEvoy, SD, Meehan, T, Menezes, AH, Muhlbauer, M, Oakes, WJ, Olavarria, G, O'Neill, BR, Ragheb, J, Selden, NR, Shah, MN, Shannon, CN, Smith, J, Smyth, MD, Stone, SSD, Tuite, GF, Wait, SD, Wellons, JC, Whitehead, WE, Park, TS, Limbrick, DD & Strahle, JM 2021, 'Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium', Journal of Neurosurgery: Pediatrics, vol. 28, no. 2, pp. 167-175. https://doi.org/10.3171/2020.12.PEDS20552

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title = "Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium",

abstract = "OBJECTIVE Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.",

keywords = "Chiari I malformation, Posterior fossa decompression, Scoliosis, Spine, Syringomyelia",

author = "Brooke Sadler and Alex Skidmore and Jordan Gewirtz and Anderson, {Richard C.E.} and Gabe Haller and Ackerman, {Laurie L.} and Adelson, {P. David} and Raheel Ahmed and Albert, {Gregory W.} and Aldana, {Philipp R.} and Alden, {Tord D.} and Christine Averill and Baird, {Lissa C.} and Bauer, {David F.} and Tammy Bethel-Anderson and Bierbrauer, {Karin S.} and Bonfield, {Christopher M.} and Brockmeyer, {Douglas L.} and Chern, {Joshua J.} and Couture, {Daniel E.} and Daniels, {David J.} and Dlouhy, {Brian J.} and Durham, {Susan R.} and Ellenbogen, {Richard G.} and Ramin Eskandari and Fuchs, {Herbert E.} and George, {Timothy M.} and Grant, {Gerald A.} and Graupman, {Patrick C.} and Stephanie Greene and Greenfield, {Jeffrey P.} and Gross, {Naina L.} and Guillaume, {Daniel J.} and Hankinson, {Todd C.} and Heuer, {Gregory G.} and Mark Iantosca and Iskandar, {Bermans J.} and Jackson, {Eric M.} and Jea, {Andrew H.} and Johnston, {James M.} and Keating, {Robert F.} and Nickalus Khan and Krieger, {Mark D.} and Leonard, {Jeffrey R.} and Maher, {Cormac O.} and Mangano, {Francesco T.} and Mapstone, {Timothy B.} and McComb, {J. Gordon} and McEvoy, {Sean D.} and Thanda Meehan and Menezes, {Arnold H.} and Michael Muhlbauer and Oakes, {W. Jerry} and Greg Olavarria and O'Neill, {Brent R.} and John Ragheb and Selden, {Nathan R.} and Shah, {Manish N.} and Shannon, {Chevis N.} and Jodi Smith and Smyth, {Matthew D.} and Stone, {Scellig S.D.} and Tuite, {Gerald F.} and Wait, {Scott D.} and Wellons, {John C.} and Whitehead, {William E.} and Park, {Tae Sung} and Limbrick, {David D.} and Strahle, {Jennifer M.}",

note = "Publisher Copyright: {\textcopyright} AANS 2021, except where prohibited by US copyright law",

year = "2021",

month = aug,

doi = "10.3171/2020.12.PEDS20552",

language = "English (US)",

volume = "28",

pages = "167--175",

journal = "Journal of Neurosurgery: Pediatrics",

issn = "1933-0707",

publisher = "American Association of Neurological Surgeons",

number = "2",

}

TY - JOUR

T1 - Extradural decompression versus duraplasty in Chiari malformation type I with syrinx

T2 - Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium

AU - Sadler, Brooke

AU - Skidmore, Alex

AU - Gewirtz, Jordan

AU - Anderson, Richard C.E.

AU - Haller, Gabe

AU - Ackerman, Laurie L.

AU - Adelson, P. David

AU - Ahmed, Raheel

AU - Albert, Gregory W.

AU - Aldana, Philipp R.

AU - Alden, Tord D.

AU - Averill, Christine

AU - Baird, Lissa C.

AU - Bauer, David F.

AU - Bethel-Anderson, Tammy

AU - Bierbrauer, Karin S.

AU - Bonfield, Christopher M.

AU - Brockmeyer, Douglas L.

AU - Chern, Joshua J.

AU - Couture, Daniel E.

AU - Daniels, David J.

AU - Dlouhy, Brian J.

AU - Durham, Susan R.

AU - Ellenbogen, Richard G.

AU - Eskandari, Ramin

AU - Fuchs, Herbert E.

AU - George, Timothy M.

AU - Grant, Gerald A.

AU - Graupman, Patrick C.

AU - Greene, Stephanie

AU - Greenfield, Jeffrey P.

AU - Gross, Naina L.

AU - Guillaume, Daniel J.

AU - Hankinson, Todd C.

AU - Heuer, Gregory G.

AU - Iantosca, Mark

AU - Iskandar, Bermans J.

AU - Jackson, Eric M.

AU - Jea, Andrew H.

AU - Johnston, James M.

AU - Keating, Robert F.

AU - Khan, Nickalus

AU - Krieger, Mark D.

AU - Leonard, Jeffrey R.

AU - Maher, Cormac O.

AU - Mangano, Francesco T.

AU - Mapstone, Timothy B.

AU - McComb, J. Gordon

AU - McEvoy, Sean D.

AU - Meehan, Thanda

AU - Menezes, Arnold H.

AU - Muhlbauer, Michael

AU - Oakes, W. Jerry

AU - Olavarria, Greg

AU - O'Neill, Brent R.

AU - Ragheb, John

AU - Selden, Nathan R.

AU - Shah, Manish N.

AU - Shannon, Chevis N.

AU - Smith, Jodi

AU - Smyth, Matthew D.

AU - Stone, Scellig S.D.

AU - Tuite, Gerald F.

AU - Wait, Scott D.

AU - Wellons, John C.

AU - Whitehead, William E.

AU - Park, Tae Sung

AU - Limbrick, David D.

AU - Strahle, Jennifer M.

PY - 2021/8

Y1 - 2021/8

N2 - OBJECTIVE Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.

AB - OBJECTIVE Scoliosis is common in patients with Chiari malformation type I (CM-I)-associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression. METHODS A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty. RESULTS In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion. CONCLUSIONS In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.

KW - Chiari I malformation

KW - Posterior fossa decompression

KW - Scoliosis

KW - Spine

KW - Syringomyelia

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SN - 1933-0707

VL - 28

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JO - Journal of Neurosurgery: Pediatrics

JF - Journal of Neurosurgery: Pediatrics

IS - 2

ER -

Extradural decompression versus duraplasty in Chiari malformation type I with syrinx: Outcomes on scoliosis from the Park-Reeves Syringomyelia Research Consortium

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