| Chapter 2(Section 1)Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric Chiari I malformationObjective The aim of this study was to compare the radiographic and clinical outcomes between the posterior fossa decompression(PFD)and posterior fossa decompression with duraplasty(PFDD)procedures in adolescent Chiari malformation Type Ⅰ(CM-I)patients.Methods Ninety adolescent patients with CMI were randomly assigned to undergo either PFDD or PFD.In both groups,a dissection from the occipital bone was performed.The dura was not opened in the PFD group,while the outer layer of dura was resected.In the PFDD group,however,the dura mater was opened and expanded.Data were analyzed for clinical outcome(Chicago Chiari Outcome Scale,CCOS),complications,and syrinx resolution.Results The age,gender,and pre-operative neurologic status were similar between the two groups.Compared to the PFD group,patients undergoing PFDD had significantly longer operation time(166min vs.119min),longer postoperative drainage time(2.50 vs.1.88),and higher drainage volume(413mL vs.73mL).At the latest follow-up,no statistically significant difference was found between the two groups in terms of syrinx resolution.The clinical outcomes were similar in the PFDD and PFD group.Compared with the PFD group,patients in the PFDD group had a higher incidence of cerebrospinal fluid(CSF)related complications(38.1%vs 2.5%).Conclusion Compared to the more aggressive decompression with duraplasty,PFD without duraplasty produces comparable radiological and clinical outcomes while being associated with a lower risk of complications.Chapter 2(Section 2)Surgical correction of thoracolumbar/lumbar scoliosis associated with Chiari Imalformation:a matched comparison with thoracolumbar/lumbar adolescent idiopathic scoliosisObjective To compare the radiographic and clinical outcomes of posterior correction between patients with Chiari-associated thoracolumbar/lumbar(TL/L)scoliosis(CMS)and those with TL/L adolescent idiopathic scoliosis(AIS).Methods 32 adolescents with TL/L CMS treated with posterior correction surgery were matched with AIS patients at a 1:1 ratio for sex,age,and curve type and magnitude.Patients were evaluated before surgery,immediately after surgery,and at latest follow-up for changes in terms of curve correction,global coronal balance,and scores on the Scoliosis Research Society(SRS)-22 questionnaire.The minimal follow up period was two years.Results The age,sex,Risser grade,and main TL/L curve magnitude were similar between the two groups,but patients with CMS were found to have significantly larger thoracic kyphosis(15° vs.23°,P=0.015).The postoperative correction of the main TL/L curve did not differ significantly between the CMS and the AIS groups(68%vs.67%,P=0.734).At the time of final follow-up,mean loss of correction was only 1.2 and 1.4 degree,respectively,in the CMS and AIS group(P=0.758).The incidence of coronal decompensation at the final follow-up was 18.75%and 15.62%,respectively,in the CMS and AIS groups(P =0.740).SRS-22 scores were similar in the CMS and AIS group at the final follow-up(3.76 vs.3.75,p>0.05).There were no neurologic complications related to surgery in either group.Conclusion In this curve-matched cohort of thoracolumbar/lumbar curves,adolescent patients with CMS were found to achieve comparable clinical and radiographic outcomes as AIS patients without increased neurologic complications.Chapter 2(Section 3)Two-stage versus one-stage posterior spinal fusion for severe spinal deformity:An analysis of safety and clinical outcomeObjective To compare the safety and clinical outcomes of the two-stage posterior release,traction,and correction surgery versus the one-stage pre-operative traction and posterior surgery in patients with severe and rigid scoliosis.Methods 30 patients treated with two-stage spinal release,halo-femoral traction,and posterior spinal fusion for severe spinal deformity were matched with 30 patients treated with one-stage posterior spine fusion surgery after halo-gravity traction according to curve type and etiology.The minimum follow-up period was two years,and the radiographic and clinical data were analyzed and compared.Results The pre-operative Cobb angle and flexibility were similar between the two groups(122.70 vs.122.53,P=0.965;and 12.95%vs.10.56%,P=0.249).At the end of traction,a statistically significant higher correction rate was achieved in the two-stage group when compared with the one-stage group(31.77%vs 18.89%,P<0.001).The higher correction rate in the two-stage group was maintained after the posterior fusion surgery(44.68%vs 38.00%,P=0.028).Larger total blood loss(2073.33±684.777 vs.1528.33±816.604,P=0.007)and shorter time of traction time(21.37±2.498 vs.83.23±28.476,P<0.001)was found in the two-stage group.Besides,no significant difference was found between the two groups in term of the pre-operative SRS-22 outcome.No neurological or other major complications were observed in this study.Conclusion Compared with the one-stage pre-operative traction and posterior fusion surgery,the two-stage posterior release,traction,and posterior fusion surgery can provide better correction rate for severe scoliosis patients,without increased complications.Chapter 3 The expression of PIEZ02 in the paraspinal muscle of Chiari malformation associated scoliosisObjective To investigate the expression of PIEZ02 in the paraspinal muscle of Chiari malformation associated scoliosis.Methods Paraspinal muscles were collected from 11 Chiari malformation associated scoliosis(CMS)patients and 4 congenital scoliosis patients as the control group.Total RNA was extracted from the muscle specimens.The expression level of PIEZ02 was compared between the two groups and the convex and concave sides of CMS patients.Results The mean age of patients in the two groups were similar.The PIEZ02 mRNA expression level did not show significant difference between the CMS group and the control group.No significant difference was found in PIEZO2 mRNA expression between the concave and convex sides of CMS patients.Conclusion No abnormal expression of PIEZ02 was found in CMS patients.Further research is required to reveal the mechanism of proprioception defects in CMS patients. |
