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Performing Surgical Treatment for Congenital Scoliosis and Intraspinal Deformity at the Same Time Appears to Be Safe Option
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Posted on: 12/27/2007
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Congenital scoliosis and/or kyphosis, curvature of the spine from birth, develops during the first eight weeks of prenatal development. At this time, other problems can develop with the spine, including tethering of the cord (spinal cord is attached to the spinal column), diastematomyelia (spinal cord is divided in half), lipoma (a non-cancerous tumor), and various others.
Many spinal abnormalities are detected by magnetic resonance images (MRIs), which are better than standard x-rays or even myelography (x-ray of the spinal cord using a contrast dye). The MRI detects from 20 percent to 58 percent of the abnormalities. The most common ones found are the tethered cord and diastematomyelia. Finding these deformities is important in order to provide correction before damage, or further damage, results. The authors of this study evaluated the effectiveness and safety of performing simultaneous surgery - correction of the scoliosis or kyphosis at the same time as the other deformities.
Twenty-one patients were included in the study. Sixteen patients had congenital scoliosis and the remaining five had congenital kyphosis. After the MRIs, seven patients were found to have a tethered cord, three had failure of segmentation, one had retethering of the cord, and 13 had diastematomyelia plus tethered cord. Four patients had neurological problems and they were in the kyphosis group.
Five patients were found to have problems with their kidneys although this was not found before the screening for the study as they had no symptoms. Cardiovascular (heart) abnormalities were found in six patients.
The simultaneous surgery took between seven to 12 hours with blood loss ranging from 1500 milliliters to 3000 milliliters. All patients stayed in intensive care for at least one day and the hospital stay ranged from five days to 12 days.
Researchers followed the patients for an average of 6.8 years. They found that no patient had any deterioration in their neurological function among the four who showed signs before the surgery. One patient needed a follow-up surgery because of a leak of spinal fluid. No infections or other surgery-related issues were found in the group.
The authors conclude that no research could be found in the English literature about similar surgical approaches. They say that, according to their study findings, performing such simultaneous surgeries was safe and effective, and eliminated the risks of having to undergo two procedures.
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References:
Azmi Hamzaoglu, MD, et al. Simultaneous Surgical Treatment in congenital Scoliosis and/or Kyphosis Associated With Intraspinal Abnormalities. In Spine. December 2007. Vol. 32. No. 25. Pp. 2880-2884.
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