Abstract：
OBJECTIVE: There is still controversy about whether it is necessary to perform prophylactic neurosurgical decompression for severe scoliosis (SS) with syringomyelia (SM) to reduce the risk of neurological complications during subsequent spinal correction. This study aimed to explore the safety and effectiveness of using traction-assisted single-stage spinal correction as a treatment for patients who had SS with SM (SS-SM).
METHODS: The patients who had SS-SM without previous neurosurgical intervention and who underwent traction-assisted single-stage posterior spinal correction at a single center were included, and the initial, posttraction, and postoperative clinical data were reviewed. Based on preoperative MRI, the included patients were divided into two categories: those with versus those without Chiari malformation type I (CM-I-related SM [CS] vs idiopathic SM [IS]), and those with a moderate syrinx (MS) versus those with a large syrinx (LS). Different groups\' traction and operation contributions were calculated for comparisons (CS vs IS, MS vs LS).
RESULTS: A total of 28 patients were included. The initial mean major scoliosis was 101.0° with a mean flexibility of 21.4%. After the operation, the mean total correction rate for scoliosis was 63.9%. The mean traction and operation contributions were 61.5% and 38.5%, respectively. Most of the patients (75%) underwent spinal corrections without 3-column osteotomies, and only 1 patient reported postoperative regional numbness without motor deficits. No differences were found in the mean total correction rates, traction, and operation contributions when comparing CS versus IS and MS versus LS with the comparable initial clinical data (p > 0.05). More than 50% of the total corrections were achieved by preoperative traction in all groups.
CONCLUSIONS: Traction-assisted single-stage spinal correction can safely and effectively correct SS-SM without prophylactic neurosurgical decompression under strict patient selection. Additionally, traction can achieve more than half of the final spinal correction, even for patients with varying sizes of SMs.
METHODS: The patients who had SS-SM without previous neurosurgical intervention and who underwent traction-assisted single-stage posterior spinal correction at a single center were included, and the initial, posttraction, and postoperative clinical data were reviewed. Based on preoperative MRI, the included patients were divided into two categories: those with versus those without Chiari malformation type I (CM-I-related SM [CS] vs idiopathic SM [IS]), and those with a moderate syrinx (MS) versus those with a large syrinx (LS). Different groups\' traction and operation contributions were calculated for comparisons (CS vs IS, MS vs LS).
RESULTS: A total of 28 patients were included. The initial mean major scoliosis was 101.0° with a mean flexibility of 21.4%. After the operation, the mean total correction rate for scoliosis was 63.9%. The mean traction and operation contributions were 61.5% and 38.5%, respectively. Most of the patients (75%) underwent spinal corrections without 3-column osteotomies, and only 1 patient reported postoperative regional numbness without motor deficits. No differences were found in the mean total correction rates, traction, and operation contributions when comparing CS versus IS and MS versus LS with the comparable initial clinical data (p > 0.05). More than 50% of the total corrections were achieved by preoperative traction in all groups.
CONCLUSIONS: Traction-assisted single-stage spinal correction can safely and effectively correct SS-SM without prophylactic neurosurgical decompression under strict patient selection. Additionally, traction can achieve more than half of the final spinal correction, even for patients with varying sizes of SMs.
摘要：
目的：对于严重脊柱侧凸（SS）伴脊髓空洞症（SM）是否需要进行预防性神经外科减压术仍存在争议，以降低后续脊柱矫正过程中神经系统并发症的风险。本研究旨在探讨使用牵引辅助单阶段脊柱矫正治疗SS伴SM（SS-SM）患者的安全性和有效性。
方法：纳入未接受神经外科手术的SS-SM患者，并在单中心接受牵引辅助单阶段后路脊柱矫正，和最初的，后牵引,并对术后临床资料进行回顾性分析。根据术前MRI,纳入的患者分为两类：有与没有Chiari畸形I型的患者（CM-I相关的SM[CS]与特发性SM[IS]），以及具有中度syrinx（MS）的人与具有大syrinx（LS）的人。计算不同组的牵引力和手术贡献进行比较(CS与IS，MSvsLS)。
结果：共纳入28例患者。初始平均主要脊柱侧凸为101.0°，平均柔韧性为21.4％。手术后,脊柱侧弯的平均总矫正率为63.9%.平均牵引和操作贡献分别为61.5%和38.5%，分别。大多数患者（75％）接受了没有三柱截骨术的脊柱矫正，只有1例患者报告术后局部麻木而无运动障碍。平均总校正率没有差异，牵引力,当比较CS与IS和MS与LS与可比较的初始临床数据时（p>0.05），以及操作贡献。在所有组中，通过术前牵引实现了总矫正的50％以上。
结论：在严格选择患者的情况下，牵引辅助单阶段脊柱矫正可以安全有效地矫正SS-SM，无需预防性神经外科减压。此外,牵引可以实现最终脊柱矫正的一半以上，即使是不同大小的SMs患者。
方法：纳入未接受神经外科手术的SS-SM患者，并在单中心接受牵引辅助单阶段后路脊柱矫正，和最初的，后牵引,并对术后临床资料进行回顾性分析。根据术前MRI,纳入的患者分为两类：有与没有Chiari畸形I型的患者（CM-I相关的SM[CS]与特发性SM[IS]），以及具有中度syrinx（MS）的人与具有大syrinx（LS）的人。计算不同组的牵引力和手术贡献进行比较(CS与IS，MSvsLS)。
结果：共纳入28例患者。初始平均主要脊柱侧凸为101.0°，平均柔韧性为21.4％。手术后,脊柱侧弯的平均总矫正率为63.9%.平均牵引和操作贡献分别为61.5%和38.5%，分别。大多数患者（75％）接受了没有三柱截骨术的脊柱矫正，只有1例患者报告术后局部麻木而无运动障碍。平均总校正率没有差异，牵引力,当比较CS与IS和MS与LS与可比较的初始临床数据时（p>0.05），以及操作贡献。在所有组中，通过术前牵引实现了总矫正的50％以上。
结论：在严格选择患者的情况下，牵引辅助单阶段脊柱矫正可以安全有效地矫正SS-SM，无需预防性神经外科减压。此外,牵引可以实现最终脊柱矫正的一半以上，即使是不同大小的SMs患者。
