Therapeutic and
diagnostic protocol for the
treatment of scoliosis
associated with
Syringomyelia
Francesco Lolli, Konstantinos Martikos,
Francesco Vommaro, Alfredo Cioni,
Mario Di Silvestre, Stefano Giacomini,
Tiziana Greggi
Surgery of Spinal Deformities
Rizzoli Orthopaedic Institute
Bologna, Italy
INTRODUCTION
Scoliosis can be associated with syringomyelia
… reported incidence varies between 25%-85%
On the other hand, syringomyelia is associated with surgical scoliosis
in 2% of the cases
The purpose of this study is provide a safe diagnostic and
therapeutic procedure to treat scoliosis in syringomyelia.
Materials and Methods
 Thirty seven patients with scoliosis
in syringomyelia were treated from
1975 to 2010
 24 females and 13 males
 Age from 1 to 52 years
 Mean follow-up 42.6 months
(range 4 to 180 months)
Materials and Methods
 Scoliosis was diagnosed before the age of 10 in 22 out of 37 cases
 The main curve of was left thoracic or thoracolumbar
 Syringomyelia was most often detected in the thoracic region
Frequently observed clinical manifestations
 Peripheral neurological deficits (19 subjects)
 Pain (14 subjects)
 13 cases presented no symptoms
Surgery
 Syringomyelia was surgically
treated in 12 patients
 Scoliosis was operated in 12 cases
correction and posterior instrumented
arthrodesis in 10 patients
arthrodesis by double approach in 1 patient
anterior arthrodesis in 1 patient
spino-costal distractor from the age of
9 until the age of 11 in 1 case
Results
 Evaluation of clinical and radiographical data of
the patients with scoliosis in syringomyelia showed
associated malformations in 27 patients
Arnold Chiari in 13 patients
Tethered cord in 7 patients
Congenital malformations of the spine in 11 patients
Kidney dysplasia in 2 patients
Hydrocephalus 2 patients
 9 patients had more than 1 associated malformation
Results
 At follow up, excellent outcome in one patient instrumented with spino-costal
distractor from the age of 9 until the age of 11, when he was instrumented
posteriorly with pedicle screws
 Very good out come in 4 cases who underwent posterior arthrodesis in
the adolescence
 Good out come with stable correction in 6 cases, although over time
revision of instrumentation was necessary in 4 patients
 Junctional kyphosis due to C6 subluxation with onset of spastic
tetraparesis was observed in 1 patient.
 One patient with hydrocephalus showed worsening of neurological
impairement in the postoperative.
Conclusions

MRI can provide surgeons with useful information for the preoperative
planning of a scoliosis and becomes mandatory when facing either a
rapidly progressive curve in juvenile age

Neurological evaluation should be recommended to complete the
preoperative clinical picture, as well as pre- and intraoperative SSEP
(somato-sensitive evoced potentials) and MEP (motor evoced potentials)

If MRI shows myeloradicular malformations, a neurosurgical assessment
becomes mandatory.

Our experience allows us to state that the diagnostic-therapeutic must be
part of the scientific and cultural background of the surgeon who deals
with spinal deformity of the spine
None of the authors has any potential conflict of interest