Scoliosis is common in patients with Chiari malformation type I (CM-I)–associated syringomyelia. While it is known that treatment with posterior fossa decompression (PFD) may reduce the progression of scoliosis, it is unknown if decompression with duraplasty is superior to extradural decompression.

A large multicenter retrospective and prospective registry of 1257 pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and syrinx (≥ 3 mm in axial width) was reviewed for patients with scoliosis who underwent PFD with or without duraplasty.

In total, 422 patients who underwent PFD had a clinical diagnosis of scoliosis. Of these patients, 346 underwent duraplasty, 51 received extradural decompression alone, and 25 were excluded because no data were available on the type of PFD. The mean clinical follow-up was 2.6 years. Overall, there was no difference in subsequent occurrence of fusion or proportion of patients with curve progression between those with and those without a duraplasty. However, after controlling for age, sex, preoperative curve magnitude, syrinx length, syrinx width, and holocord syrinx, extradural decompression was associated with curve progression > 10°, but not increased occurrence of fusion. Older age at PFD and larger preoperative curve magnitude were independently associated with subsequent occurrence of fusion. Greater syrinx reduction after PFD of either type was associated with decreased occurrence of fusion.

In patients with CM-I, syrinx, and scoliosis undergoing PFD, there was no difference in subsequent occurrence of surgical correction of scoliosis between those receiving a duraplasty and those with an extradural decompression. However, after controlling for preoperative factors including age, syrinx characteristics, and curve magnitude, patients treated with duraplasty were less likely to have curve progression than patients treated with extradural decompression. Further study is needed to evaluate the role of duraplasty in curve stabilization after PFD.

脊柱侧弯在 Chiari 畸形 I 型 (CM-I) 相关脊髓空洞症患者中很常见。虽然已知后颅窝减压 (PFD) 治疗可以减少脊柱侧弯的进展，但硬脑膜成形术减压是否优于硬膜外减压尚不清楚。

一项大型多中心回顾性和前瞻性登记研究纳入了 1257 名患有 CM-I（扁桃体在枕骨大孔下方 ≥ 5 mm）和空洞（轴向宽度≥ 3 mm）的儿童患者，这些患者接受了 PFD 伴或不伴硬脊膜成形术的脊柱侧弯患者。

总共有 422 名接受 PFD 的患者临床诊断为脊柱侧弯。在这些患者中，346 人接受了硬膜成形术，51 人接受了单独的硬膜外减压，25 人被排除在外，因为没有关于 PFD 类型的数据。平均临床随访时间为 2.6 年。总体而言，在进行硬膜成形术的患者和未进行硬膜成形术的患者之间，随后的融合发生率或曲线进展患者的比例没有差异。然而，在控制了年龄、性别、术前弯道幅度、空洞长度、空洞宽度和全息空洞后，硬膜外减压与弯道进展 > 10°相关，但没有增加融合的发生率。PFD 年龄较大和术前弯曲幅度较大与随后发生的融合独立相关。

在接受 PFD 的 CM-I、空洞和脊柱侧弯患者中，接受硬膜成形术的患者和接受硬膜外减压术的患者在随后的脊柱侧弯手术矫正中没有差异。然而，在控制了包括年龄、空洞特征和弯曲幅度在内的术前因素后，接受硬膜成形术治疗的患者比接受硬膜外减压治疗的患者更不可能出现弯曲进展。需要进一步研究来评估硬膜成形术在 PFD 后曲线稳定中的作用。