Conditions - The Chiari I Abnormality in Childhood

Figure 16This is a boy that came into us [see Figure 16] with difficulty with his hands and there is a problem in front here with a syrinx and a Chiari. So thats taken care of, in this case it wont go away with traction, we tried it, because he needed an operation from in front and from behind. I dont want to step on the material that Dr. Batzdorf is going to talk upon, the spinal deformity, but we were interested in this a long time ago and reviewed our series. It was said that patients who had scoliosis of more than 30 would never correct unless they had a major scoliosis operation.

Figure 17Figure 18

What we showed was that if they are operated on, early on, below the age of 12, that 80-90% of them by 12 (were talking about puberty) crossing over, growth spurt and changes in the bony configurations, that this can be handled earlier and get by without doing a scoliosis operation. Can we prove it? Theres a child that comes in with this big combination, [see Figure 17] weve got a portion hanging down here, the cavity in the spinal cord, this is accompanied by not a bad scoliosis but about a 20 angulation. This is the post-op MRI. [see Figure 18]

Figure 19All of our patients get a MRI, many within the first three months and then at one year and we follow them through puberty. The cavity is gone, what happened to the syrinx? [see Figure 19] And its over. Why? Because weve taken away the compression, the cavity has gone away. We were talking to somebody just this morning, you take care of the root cause and most of it takes care of itself. Is this a passing phase? No, lets look at another one. [see Figure 20] Same problem, everything is jammed up here, this is a situation called cervical medullary buckle where the medulla is pushed down.

Figures 20 and 21Somebody that I look up to, Peter Carmel, described this very early, 1972. This is something I always look at, and if I see it there then I know Ive got a very big problem. Dr. Milhorat has described this too. But heres a big cavity in the spinal cord. Thats post op, [see Figure 20] things look good, thats the scoliosis [see Figure 21] before the procedure, thats within 6 months. I am very fortunate to be associated with a pediatric orthopedist, Dr. Weinstein, and hopefully we can get him to talk at the meeting next year. Dr. Weinstein sees about 1500 kids a year and performs something like 200 scoliosis operations. Dr. Weinstein sees the scoliosis and if theres anything abnormal they automatically all get MRIs and then I take care of them and then he follows through to make sure things have gotten well. He was co-author in some of this material and what youre seeing here, has changed orthopedic thinking. We put these kids in a brace to see if thats going to take care of it and over a period of 6 months we had an improvement. Not everybody does, but Ill figure sure about 86% of them will get better. Im talking about our whole series of scoliosis.