ABSTRACT

A 16.5-year-old boy underwent concomitant posterior fossa decompression (PFD) for CM-I and spinal curve correction. Preop MRI evaluation revealed a CM-I, cervicothoracic syringomyelia. A thoracic kyphosis (62°) with a double thoracic scoliotic curve (40°, 42°) diagnosed. A preoperative neurological examination revealed numbness in the left arm and a slight loss of motor function. Under intraoperative neurophysiological monitoring (IONM), a PFD and resection of C1 vertebra were performed before the surgical correction of the spinal deformity. Posterior pedicle screws were applied to vertebrae between T2 and L1. IONM revealed a clear improvement in the left arm following PFD. A postoperative magnetic rezonans imaging revealed a satisfactory decompression at the craniocervical junction and a significant improvement of the syrinx. Follow-up study after 3 years later showed that proximal thoracic angle was 10°, main thoracic angle was 10°, and lateral Cobb angle was 42°. Deformity correction surgery and treatment for CM-I performed in one session seems relatively new. IONM is vital in assessing a patient’s condition prior to surgical operation and changes, which occur during surgery, as well as evaluation the follow-up period. Our study showed that PFD and spinal curve correction can be conducted in a single surgical session.