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Passias PG, Pyne A, Horn SR, et al. Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg. 2018;4(1):45-54doi: 10.21037/jss.2018.03.14.
Passias, P. G., Pyne, A., Horn, S. R., Poorman, G. W., Janjua, M. B., Vasquez-Montes, D., Bortz, C. A., Segreto, F. A., Frangella, N. J., Siow, M. Y., Sure, A., Zhou, P. L., Moon, J. Y., Diebo, B. G., & Vira, S. N. (2018). Developments in the treatment of Chiari type 1 malformations over the past decade. Journal of spine surgery (Hong Kong), 4(1), 45-54. https://doi.org/10.21037/jss.2018.03.14
Passias, Peter G, et al. "Developments in the treatment of Chiari type 1 malformations over the past decade." Journal of spine surgery (Hong Kong) vol. 4,1 (2018): 45-54. doi: https://doi.org/10.21037/jss.2018.03.14
Passias PG, Pyne A, Horn SR, Poorman GW, Janjua MB, Vasquez-Montes D, Bortz CA, Segreto FA, Frangella NJ, Siow MY, Sure A, Zhou PL, Moon JY, Diebo BG, Vira SN. Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg. 2018 Mar;4(1):45-54. doi: 10.21037/jss.2018.03.14. PMID: 29732422; PMCID: PMC5911752.
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J Spine Surg. 2018 Mar;4(1):45-54. doi: 10.21037/jss.2018.03.14.

Developments in the treatment of Chiari type 1 malformations over the past decade.

Journal of spine surgery (Hong Kong)

Peter G Passias, Alexandra Pyne, Samantha R Horn, Gregory W Poorman, Muhammad B Janjua, Dennis Vasquez-Montes, Cole A Bortz, Frank A Segreto, Nicholas J Frangella, Matthew Y Siow, Akhila Sure, Peter L Zhou, John Y Moon, Bassel G Diebo, Shaleen N Vira

Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA.
  2. Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.

PMID: 29732422 PMCID: PMC5911752 DOI: 10.21037/jss.2018.03.14

Abstract

BACKGROUND: Chiari malformations type 1 (CM-1), a developmental anomaly of the posterior fossa, usually presents in adolescence or early adulthood. There are few studies on the national incidence of CM-1, taking into account outcomes based on concurrent diagnoses. To quantify trends in treatment and associated diagnoses, as retrospective review of the Kid's Inpatient Database (KID) from 2003-2012 was conducted.

METHODS: Patients aged 0-20 with primary diagnosis of CM-1 in the KID database were identified. Demographics and concurrent diagnoses were analyzed using chi-squared and

RESULTS: Five thousand four hundred and thirty-eight patients were identified in the KID database with a primary diagnosis of CM-1 (10.5 years, 55% female). CM-1 primary diagnoses have increased over time (45 to 96 per 100,000). CM-1 patients had the following concurrent diagnoses: 23.8% syringomyelia/syringobulbia, 11.5% scoliosis, 5.9% hydrocephalus, 2.2% tethered cord syndrome. Eighty-three point four percent of CM-1 patients underwent surgical treatment, and rate of surgical treatment for CM-1 increased from 2003-2012 (66% to 72%, P<0.001) though complication rate decreased (7% to 3%, P<0.001) and mortality rates remained constant. Seventy percent of surgeries involved decompression-only, which increased neurologic complications compared to fusions (P=0.039). Cranial decompressions decreased from 2003-2012 (42.2-30.5%) while spinal decompressions increased (73.1-77.4%). Fusion rates have increased over time (0.45% to 1.8%) and are associated with higher complications than decompression-only (11.9%

CONCLUSIONS: CM-1 diagnoses have increased in the last decade. Despite the decrease in overall complication rates, fusions are becoming more common and are associated with higher peri-operative complication rates. Commonly associated diagnoses including syringomyelia and hydrocephalus, can dramatically increase complication rates.

Keywords: Chiari; Chiari malformations type 1 (CM-1); complication rates; pediatrics; spinal decompression

Conflict of interest statement

Conflicts of Interest: Dr. PG Passias reports personal consulting fees for Spinewave, Zimmer Biomet, and Medicrea, grants to the institution from the Cervical Spine Research Society. The other authors

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