| BackgroundCongenital scoliosis(CS)is formed during the first 8 weeks of embryonic development due to abnormal development of the vertebral body and at the same time as the critical period of neural tube closure.Therefore,in addition to abnormal spinal body development,patients with CS are often associated with spinal deformities and other organ defects.Split cord malformation(SCM)is a deformity in the spinal canal that occurs during embryonic development.Therefore,SCM often occurs simultaneously with CS,SCM is found to be the most common intravertebral deformity in patients with CS,SCM is divided into 2 types:type Ⅰ SCM(2 hemicords,each in its own dural tube,separated by a dural-sheathed osseous or cartilaginous medial septum)and type Ⅱ SCM(2 hemicords in a single dural tube divided by a fibrous or membranous septum).CS with SCM is a major challenge for spinal surgeons.For patients with CS and SCM,how to formulate an appropriate surgical plan can not only ensure the stability of nerve function,but also achieve satisfactory correction,which has been a hot topic in research for many years.There has been no unified opinion on the treatment of patients with CS and SCM in the historical literature,There is much controversy.In the past,in order to avoid creating a neurologic deficit or aggravating a pre-existing neurologic deficit,it was widely accepted that all patients with CS and SCM should undergo prophylactic neurosurgical intervention before orthopedic surgery no matter what type of SCM.Later researchers had found that patients with CS and type Ⅱ SCM were safe without prophylactic neurosurgical intervention.However,it is generally believed that SCM requires prophylactic neurosurgical intervention for patients with CS and type ⅠSCM,because the osseous or cartilaginous medial septum is likely to stretch the spinal cord and cause neurologic deficit Recently,some scholars have proposed that for patients with stable or no obvious neurological symptoms,combined with typeⅠ or type Ⅱ SCM can undergo orthopedics without prophylactic neurosurgical intervention.ObjectiveTo compare the surgical efficacy of CS with stable or no obvious neurological symptoms combined with type Ⅰ or type Ⅱ in direct orthopedic surgery without prophylactic neurosurgical intervention.MethodsPatients with CS and SCM who underwent corrective surgery in a single institution from June 2010 to September 2017 were retrospectively evaluated,including basic information and perioperative data(Age,length of stay,length of operation,amount of bleeding,amount of blood transfusion)and imaging data(preoperative,postoperative 2 weeks,and last follow-up spine X-rays,and left-right Bending images),measurement imaging parameters,including:Cobb angle of the main major coronal curves(MC),apical vertebra translation(AVT),apical vertebral rotation(AVR),coronal balance(CB),thoracic trunk shift(TTS),clavicle angle(CA),sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),flexibility index(FI).80 patients were included to meet the inclusion criteria:all patients underwent scoliosis orthopedics but did not undergo prophylactic neurosurgery intervention.Ultrasound was used to examine the urinary system and deep venous of both lower extremities,and echocardiography was used to assess the heart.On the basis of the classification of SCM by Pang,patients were separated into type Ⅰ(CS with type Ⅰ SCM)and type Ⅱ(CS with type Ⅱ SCM)groups.Compare the basic information,perioperative data,and complications of the two groups;use an independent samples t test and chi-square test or Fisher exact test to compare and analyze clinical results and imaging parameters of two groups.ResultA careful review of 80 patients with CS and SCM was performed,and the average follow-up period was 2.9 years(2～5 years).Among them,there were 7 males and 29 females in the type Ⅰ group,with an average age of 14.2±6.9 years at surgery;12 males and 32 females in the type Ⅱ group,with an average age of 16.2 ±5.7 years at surgery.There were no statistically significant differences in age,operative time,blood loss,blood transfusion volume,and hospital stay in the two groups(P>0.05);There were no significant differences in the preoperative Cobb angle,flexibility index,apical vertebra translation,apical vertebral rotation,coronal balance,thoracic trunk tilt,sagittal vertical axis,clavicle angle,thoracic kyphosis and lumbar lordosis(P>0.05).There was no statistically significant difference in correction rates between the two groups after surgery(51.2±18.6:53.4±20.7,P>0.05)and the last follow-up(44.7±17.5:48.0±18.6,P>0.05),and there was no difference in orthopedic effect.Except for a significant difference between the 2 groups in terms of postoperative and last follow-up apical vertebral rotation,there was no significant difference between the two groups of postoperative and last follow-up imaging data.There was no significant difference in the total complications(11.1%:6.8%)and major complications(8.3%:4.5%)in the type Ⅰ group and the typeⅡ group(P>0.05).ConclusionIn summary,our research shows that,for patients with CS associated type Ⅰ or type Ⅱ SCM with stable or no obvious neurological symptoms,the same orthopedic results can be obtained without prophylactic neurosurgical intervention.There was no significant difference in perioperative complications between type Ⅰ or type Ⅱ SCM. |
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