Single-group Study to Explore the Optimal Management of Neuropathic Scoliosis Caused by Neural Axis Abnormalities Based on its Clinical Features

Although it is not easy to differentiate neuropathic scoliosis caused by neural axis abnormalities (NAAs) from idiopathic scoliosis for lack of neurological signs, neuropathic scoliosis caused by NAAs has some specific clinical findings. The purpose of this study was to investigate the characteristics of neuropathic scoliosis caused by NAAs and to discuss the essential points of diagnosis and treatment. From 1998 through 2008, 622 new patients visited our scoliosis outpatient clinic. Of those, 12 patients with neuropathic scoliosis caused by NAAs diagnosed by cervical MRI were involved in this study. They included 5 boys and 7 girls with a mean age of 10 years and 5 months. We investigated the relationship of NAAs, treatment methods for scoliosis, and effects of neurosurgical treatment for prognosis of outcome. There were 10 cases of syringomyelia with Chiari malformation type I, 1 case of syringomyelia alone, and 1case of spinal cord tumor. Surgery was performed in 3 cases, an under arm brace was prescribed in 6 cases, and observation was selected in 3 cases. Scoliotic curves were improved in 4 out of the 11 cases on whom neurosurgical intervention for the relationship of NAAs were performed. The Cobb angles before surgery of these 4 cases were less than 30° and 3 of the 4 cases were 8 years old or less. We would emphasize that early treatment for the relationship of NAAs at younger age (≤8 yrs) and before curve progression (<30°) should be actively enforced for favorable prognosis of neuropathic scoliosis caused by NAAs.