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The Expert Advisor
Featured Article:
The Chiari I Abnormality in Childhood
Arnold H. Menezes, MD
The following article is a transcribed presentation from the 2004
ASAP Conference. You will find this and many more presentations in
our
2004 Conference Notebook.
Page 5
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This 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. |
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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] |
All 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. |
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Somebody 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. |
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