Simultaneous Surgical Treatment for Congenital Scoliosis or Kyphosis and Intramedullary Abnormalities

Purpose: Retrospective evaluation of 16 patients who had simultaneous surgical treatment for progressive spinal deformity and co-existing intramedullary pathologies (tethered cord ± diastematomyelia). Classical approach in such patients is first to perform surgery for the intramedullary pathologies and then surgery for correction and stabilization of the deformity 3 to 6 months later. To our knowledge there are not many studies on simultaneous surgical treatment for these two conditions.

Methods: 16 patients aged 2-21 years were operated between 1994-2000. Of these, 3 had congenital kyphosis due to hemivertebra, 1 had congenital scoliosis and 12 had mixed deformities. As the intramedullary pathologies, 5 had tethered cord, 1 had retethering and 10 had diastematomyelia with tethered cord. 4 patients had neurological deficit preoperatively. Posterior exposure and placement of all pedicle screws was performed as the initial part of surgical procedure. Then intramedullary pathologies were treated by the neurosurgical team. Then followed completion of instrumentation and correction of the deformity. Posterior instrumentation for correction of the deformity was short segment in 4 patients and long segment in the remaining 12. Also vertebrectomy via posterior approach was performed in 5 patients and 3 later had additional anterior surgery to prevent pseudoarthrosis and crankshaft. A combination of autograft and allograft was used for achieving fusion in all patients.

Results: Average follow-up was 3.4 (3-8) years. None of the patients had deterioration of their neurological status postoperatively. For the patients with preoperative neurological deficit, recovery was complete in two, neurologic status was better in one and unchanged in the other. None of the patients had infection, pseudoarthrosis or loss of correction.

Conclusion: Simultaneous surgical treatment for congenital deformity and intramedullary abnormality does not involve significant complications. Being a single-stage surgical procedure it forms a safe and attractive treatment option.