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• W3080453712 abstract "Commentary Tan et al. have offered us an intimate look at a subclassification of scoliosis, syringomyelia-associated scoliosis, that has received less attention in the orthopaedic literature than it deserves. They looked specifically at whether syringomyelia differs when it is associated with a Chiari-I malformation, and whether any detected differences change outcomes from surgical treatment of the scoliosis. To answer these questions, they assembled a fairly large cohort of patients (120) for presurgical analysis; from that cohort, they then selected 21 carefully matched patients in each category—Chiari I-malformation (CIM) and idiopathic syringomyelia (ISm)—for post-surgical analysis. Tan et al. concluded that, although CIM was associated with longer syrinxes, outcomes were similar, except that there were more complications (particularly postoperative adding-on) in the ISm group. Although this increase was not statistically significant, the difference in complications is striking and suggests the need for study in a larger cohort. Neurologic complications were not seen in either group. The authors’ conclusions must be interpreted with several points in mind. First, 36 patients were excluded from their study because they had received preoperative neurosurgical treatment for the syrinx. One would presume that those who required suboccipital decompression or syrinx drainage had more serious neurosurgical deficits than those who did not. However, because these patients were not analyzed further, I can state only that the results that the authors obtained do not necessarily apply to patients who have had neurosurgical intervention prior to scoliosis surgery. It would be interesting to determine if the surgical results from scoliosis surgery in this subgroup differ from those reported in the current study. Second, although this was a study of patients who did not undergo preoperative syrinx drainage or decompression, it cannot be taken as an endorsement of that approach. The need for treatment of the syrinx before surgery on the scoliosis remains controversial1,2; however, as was the case with this cohort, all patients with a syrinx should be referred to a neurosurgeon for evaluation before scoliosis surgery and a decision regarding the need for preoperative drainage of the syrinx should be based on clinical findings at the time, the potential for syrinx progression in the future, and the degree to which scoliosis surgery would interfere with magnetic resonance imaging (MRI) evaluation of the syrinx and later drainage if required. Third, neurologic deficits due to syringomyelia can be quite subtle. If the syrinx extends proximally enough, cranial nerves can be involved. Because of the tendency of the syrinx to damage decussating fibers, pain fibers are particularly prone to injury. Therefore, thermal testing and pinprick testing are important facets of the physical examination. Testing must encompass all of the dermatomes over the length of the syrinx and below. Not all orthopaedic surgeons are comfortable with the examinations required. On the other hand, orthopaedic surgeons are well-equipped to detect Charcot joints, which also can be subtle early on and are frequent in syringomyelia, particularly in the upper extremity. Thus, a working partnership between orthopaedic surgeons and their neurosurgical colleagues is important when assessing these patients. The syrinx status needs to be monitored after scoliosis surgery—particularly in patients who have not had a decompression procedure—with expert regular neurologic examinations and MRI as indicated." @default.
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• W3080453712 date "2020-08-19" @default.
• W3080453712 modified "2023-09-23" @default.
• W3080453712 title "What Is the Clinical Importance of a Chiari-I Malformation in a Patient with Syringomyelia and Surgically Treated Scoliosis?" @default.
• W3080453712 cites W2606414562 @default.
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• W3080453712 doi "https://doi.org/10.2106/jbjs.20.01073" @default.
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