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Is Curve Direction Correlated With the Dominant Side of Tonsillar Ectopia and Side of Syrinx Deviation in Patients With Single Thoracic Scoliosis Secondary to Chiari Malformation and Syringomyelia?

Zhu, Zezhang MD*; Wu, Tao PhD; Sha, Shifu PhD*; Sun, Xu MD*; Zhu, Feng MD*; Qian, Bangping MD*; Qiu, Yong MD*

Spine:
doi: 10.1097/BRS.0b013e3182796ec5
Deformity
Abstract

Study Design. A retrospective imaging study.

Objective. To conduct an assessment of the correlation of the coronal asymmetries between tonsillar ectopia, syrinx, and scoliosis.

Summary of Background Data. A few reports have shown that the convex side of scoliosis was on the same side as the dominant tonsillar ectopia or syrinx deviation in a majority of patients. However, this issue remains controversial.

Methods. A retrospective study was conducted on young patients with a single thoracic scoliosis secondary to Chiari malformation type I and syringomyelia. The curve direction, side of the dominant tonsillar ectopia and side of the syrinx deviation were recorded and assessed quantitatively. The correlations between the asymmetrically displaced tonsils, eccentrically located syrinx, and curve convexity were investigated.

Results. A total of 39 patients were included. The concordance between the deviated side of the eccentrically located syrinx and dominant side of the asymmetrically displaced tonsils was 87.0%. In 88.5% of the patients with an asymmetrically displaced tonsil, the convex side of the scoliosis was concordant with the dominant side of the tonsillar ectopia, and in 86.2% of patients with an eccentrically located syrinx, the convex side of the scoliosis was on the same side as the deviated side of the syrinx. In addition, the dominant tonsillar ectopia, syrinx deviation, and curve direction were all on the same side in 82.6% patients with asymmetrically displaced tonsils and eccentrically located syrinx.

Conclusion. Asymmetrically displaced tonsils and eccentrically located syrinxes were common imaging features in these patients. The thoracic spine tended to be convex to not only the dominant side of the asymmetrically displaced tonsil, but also the deviated side of the eccentrically located syrinx. The effect of syrinx deviation on curve convexity is similar to that of dominant tonsillar ectopia in the majority of patients.

In Brief

Tonsillar ectopia and syrinxes were often asymmetrical in patients with a single thoracic scoliosis secondary to Chiari malformation type I and syringomyelia. The thoracic spine tended to be convex to not only the dominant side of the asymmetrically displaced tonsil but also the deviated side of the eccentrically located syrinx.

Author Information

*Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; and

Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.

Address correspondence and reprint requests to Yong Qiu, MD, Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing 210008, China; E-mail: scoliosis2002@sina.com

Acknowledgment date: July 17, 2012. Revision date: September 20, 2012. Acceptance date: October 14, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Natural Science Foundation of China (Grant No. 81171672) funds were received in support of this work.

No relevant financial activities outside the submitted work.

The first 2 authors contributed equally to this work.

© 2013 Lippincott Williams & Wilkins, Inc.