Our Summary

This research paper looks at the relationship between two medical conditions: Chiari 1 malformation (a brain condition) and scoliosis (a curvature of the spine). The link between these two conditions has been established in previous studies, and it’s become more common to identify people with both, thanks to advances in medical imaging technology like MRIs.

In children who have both Chiari 1 and scoliosis, it’s common to perform a certain type of surgery, called suboccipital decompression, before correcting the scoliosis. This is a preventative measure, done to avoid potential injury to the spinal cord. But the researchers note that there isn’t a clear consensus on whether this preventative surgery is truly necessary or beneficial.

To try and answer this question, the researchers reviewed a large number of studies, published between 1972 and 2018. Of the 3,250 studies they looked at, only four met their criteria for inclusion in the review. The researchers found that none of the four studies provided strong enough evidence to recommend the preventative surgery before correcting the scoliosis.

In simpler terms, this research is questioning a common practice in treating children with both a brain condition and a spine condition. They found that the evidence supporting the use of a preventative surgery before treating the spine condition is not very strong, suggesting that it might be safe to go ahead with the scoliosis correction without doing the preventative surgery first. However, more research is likely needed to confirm this.

FAQs

  1. What is the association between Chiari 1 malformation and scoliosis?
  2. What is the purpose of prophylactic suboccipital decompression prior to scoliosis correction in children with Chiari 1 malformation?
  3. Is it safe to proceed with scoliosis correction without prior prophylactic suboccipital decompression for Chiari 1 in an asymptomatic population?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric scoliosis surgery is to discuss the potential risks and benefits of prophylactic suboccipital decompression for Chiari 1 malformation before proceeding with the surgery. It is important to consider the individual patient’s specific case and consult with a multidisciplinary team of specialists to determine the best course of action for optimal outcomes.

Suitable For

Patients with pediatric scoliosis who also have Chiari 1 malformation are typically recommended for surgery. However, the decision to perform prophylactic suboccipital decompression prior to scoliosis correction in these patients is still a topic of debate in the medical community. The literature review conducted in this study found that there is currently not enough strong evidence to support the need for prophylactic decompression in asymptomatic pediatric patients with Chiari 1 malformation undergoing scoliosis surgery. Further research is needed to determine the optimal surgical management for this patient population.

Timeline

  • Patient is diagnosed with scoliosis and Chiari 1 malformation through imaging studies
  • Patient undergoes evaluation by a multidisciplinary team including orthopedic surgeons and neurosurgeons
  • Decision is made to proceed with scoliosis surgery, with consideration for prophylactic suboccipital decompression for Chiari 1 malformation
  • Patient undergoes pre-operative testing and preparation for surgery
  • Scoliosis surgery is performed, with or without prior prophylactic suboccipital decompression
  • Patient is monitored closely in the immediate post-operative period for any complications
  • Patient undergoes physical therapy and rehabilitation to regain strength and mobility
  • Long-term follow-up is conducted to monitor the patient’s spinal alignment and neurological status
  • Patient may require ongoing monitoring and management for any residual symptoms or complications from the surgery

What to Ask Your Doctor

  1. What is the likelihood of developing spinal cord injury if scoliosis surgery is performed without prior prophylactic decompression for Chiari 1 malformation?
  2. What are the potential risks and benefits of undergoing prophylactic suboccipital decompression prior to scoliosis surgery in cases of Chiari 1 malformation?
  3. Are there any alternative treatment options or considerations for managing Chiari 1 malformation in conjunction with scoliosis surgery?
  4. How will the presence of Chiari 1 malformation impact the surgical approach and outcomes of scoliosis surgery in pediatric patients?
  5. What is the expected recovery and long-term prognosis for pediatric patients undergoing scoliosis surgery with or without prophylactic decompression for Chiari 1 malformation?
  6. Are there any specific criteria or indicators that would warrant prophylactic decompression prior to scoliosis surgery in pediatric patients with Chiari 1 malformation?
  7. What is the experience and success rate of the surgical team in performing scoliosis surgery in conjunction with Chiari 1 malformation in pediatric patients?
  8. Are there any post-operative care or follow-up considerations that are unique to pediatric patients undergoing scoliosis surgery with Chiari 1 malformation?

Reference

Authors: Rodriguez VV, Tello CA, Piantoni L, Wilson IAF, Galareto E, Remondino RG, Bersusky SE, Davies R, Noel MA. Journal: Spine Deform. 2021 Sep;9(5):1253-1258. doi: 10.1007/s43390-021-00336-0. Epub 2021 Apr 1. PMID: 33792837