Volume 8 Supplement 1

9th International Conference on Conservative Management of Spinal Deformities - SOSORT 2012 Annual Meeting

Open Access

Conservative treatment of juvenile with Chiari I malformation, syringomyelia and scoliosis. Two case reports

  • M Rigo1,
  • B Janssen2,
  • R Campo2 and
  • L Tremonti2
Scoliosis20138(Suppl 1):O52

https://doi.org/10.1186/1748-7161-8-S1-O52

Published: 3 June 2013

Background

Scoliosis improvement after surgical treatment of Chiari I and syrinx has been reported [1]. Incidence of scoliosis progression after decompression surgery has been reported as high as 48%. The conservative treatment with brace in these patients is not effective and scoliosis is typically progressive [2]. Spontaneous resolution of CT syrinx and Chiari I in paediatric population is uncommon. We have previously published a unique case report of an 8-year-old girl, showing resolution of syrinx and Chiari I, as well as scoliosis reduction of scoliosis during brace treatment [3]. We present results after longer follow up, together with a new case of good response to bracing, in a girl showing scoliosis progression after neurosurgical treatment.

Case Presentation

First case presentation

A 7-year-old girl who showed scoliosis progression from 44º to 55º six months after neurosurgical decompression to treat Chiari I (10-11 mm tonsillar ectopia) associated with C5-T11 syrinx was subsequently recommend going under scoliosis surgery (rejected). Eight months following neurosurgery, patient began full-time treatment with a Chêneau type brace (RSC). She started later a program of specific exercises based on Schroth-Barcelona (BSPTS). At 12 years of age (5 years follow-up) she shows a 6º main thoracic curve in her 4th brace, although still at Risser 0. Formetric reports a totally regressed back asymmetry and physiological sagittal profile. The patient is asymptomatic and continues full time bracing and exercises.

Second case presentation

A 13-year-old girl started full time bracing when she was 8 years old, after showing progression from 36º to 47º in five months in her right thoracic scoliosis associated with symptomatic Chiari I and C4-T9-10 syrinx. She showed spontaneous resolution of Chiari I and almost resolution of syrinx with no recurrence, and good response to bracing. At five years follow-up she continues partial-time bracing (16 H) and BSPTS exercises, asymptomatic, with a main thoracic curve of 17º (combined with 17º functional left lumbar), one-year post-menarche and Risser 3. Back asymmetry is totally regressed and sagittal profile physiologic.

Conclusion

Conservative treatment should be considered in patients with Chiari I/syrinx associated to progressive scoliosis, prior to or post-neurosurgical intervention, and prior to scoliosis surgery.

Authors’ Affiliations

(1)
Institut Elena Salvá
(2)
ScoliosisRehab

References

  1. Mollano AV, Weinstein SL, Menezes AH: Significant scoliosis regression following syringomyelia decompression: case report. Iowa Orthop J. 2005, 25: 57-59.PubMed CentralPubMedGoogle Scholar
  2. Colombo LF, Motta F: Consensus conference on Chiari: a malformation or an anomaly? Scoliosis and others orthopaedic deformities related to Chiari 1 malformation. Neurol Sci. 32 (Suppl 3): S341-343.Google Scholar
  3. LM RMaM: Spontaneous resolution of a Chiari malformation and cervicothoracic syrinx in a 9 years old girl with a 47º scoliosis responding favorably to bracing. scoliosis. 2009, 4 (suppl 1): 0-58.Google Scholar

Copyright

© Rigo et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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