The pathophysiology behind the instigation and progression of scoliosis in Chiari malformation type I (CMI) patients has not been elucidated yet. This study aims to explore the initiating and progressive factors for scoliosis secondary to CMI. Pediatric patients with CMI were retrospectively reviewed for radiological characteristics of tonsillar herniation, craniocervical anomaly, syrinx morphology, and scoliosis. Subgroup analyses of the presence of syrinx, scoliosis, and curve progression were also performed. A total of 437 CMI patients were included in the study; 62% of the subjects had syrinx, and 25% had scoliosis. In the subgroup analysis of 272 CMI patients with syrinx, 78 of them (29%) had scoliosis, and multiple logistic regression analysis showed that tonsillar herniation ≥ 10 mm (OR 2.13; P = 0.033) and a clivus canal angle ≤ 130° (OR 1.98; P = 0.025) were independent risk factors for scoliosis. In the subgroup analysis of 165 CMI patients without syrinx, 31 of them (19%) had scoliosis, and multiple logistic regression analysis showed that a clivus canal angle ≤ 130° (OR 3.02; P = 0.029) was an independent risk factor for scoliosis. In the subgroup analysis of curve progression for 97 CMI patients with scoliosis, multiple logistic regression analysis showed that anomalies of the craniocervical junction and syrinx were not risk factors for curve progression. Many complex factors including craniocervical angulation, tonsillar herniation, and syrinx might participate in the instigation of scoliosis for CMI patients, and the relationship between craniocervical angulation and scoliosis deserves further study.

Chiari 畸形 I 型 (CMI) 患者脊柱侧弯的诱发和进展背后的病理生理学尚未阐明。本研究旨在探讨继发于 CMI 的脊柱侧弯的起始和进展因素。对患有 CMI 的儿科患者的扁桃体突出、颅颈异常、空洞形态和脊柱侧弯的放射学特征进行回顾性研究。还对存在的空洞、脊柱侧弯和曲线进展进行了亚组分析。该研究共包括 437 名 CMI 患者；62% 的受试者有空洞，25% 有脊柱侧弯。272例CMI患者的亚组分析中，78例（29%）有脊柱侧弯，多元logistic回归分析显示扁桃体突出≥10 mm（OR 2.13；P= 0.033）和斜坡管角度≤ 130°（OR 1.98；P = 0.025）是脊柱侧弯的独立危险因素。165例无空洞的CMI患者亚组分析中，31例（19%）有脊柱侧弯，多元logistic回归分析显示斜坡管角度≤130°（OR 3.02；P= 0.029) 是脊柱侧弯的独立危险因素。在97例CMI脊柱侧弯患者的曲线进展亚组分析中，多元logistic回归分析显示，颅颈交界处和空洞的异常不是曲线进展的危险因素。颅颈成角、扁桃体突出、空洞等复杂因素可能参与CMI患者脊柱侧弯的诱发，颅颈成角与脊柱侧弯的关系值得进一步研究。