SPINE Volume 32, Number 25, pp 2880 –2884 ©2007, Lippincott Williams & Wilkins, Inc. Simultaneous Surgical Treatment in Congenital Scoliosis and/or Kyphosis Associated With Intraspinal Abnormalities Azmi Hamzaoglu, MD,* Cagatay Ozturk, MD,* Mehmet Tezer, MD,* Mehmet Aydogan, MD,* Mercan Sarier, MD,* and Ufuk Talu, MD† Study Design. Retrospective clinical study. Objective. To show retrospective analysis of 21 con- secutive patients who underwent simultaneous surgical treatment for progressive spinal deformity and coexisting intraspinal pathologies (tethered cord and/or diastemato- myelia). Summary of Background Data. The classic advocated approach in patients with congenital spine deformity as- sociated with intraspinal anomalies is first to perform surgery for the intraspinal pathologies and then surgery for correction and stabilization of the deformity 3 to 6 months later. To our knowledge, there is no study on simultaneous surgical treatment for these 2 associated conditions. Methods. In the surgery; after the exposure of the determined levels, placement of all pedicle screws was performed as the initial part of surgical procedure. Then surgical treatment for intraspinal pathology was per- formed by the neurosurgical team and then followed by completion of instrumentation and correction of the de- formity. Additional anterior surgery was done later to prevent pseudarthrosis and crankshaft phenomenon. Results. The mean age of the patients at presentation ranged from 3 to 19 years (mean, 13 years). There were 17 female patients and 4 male patients. Four patients had neurologic deficits at the time of presentation, and all 4 had associated kyphosis. The mean operation time was 9.3 hours (range, 7–12 hours) and the mean blood loss was 1980 mL (range, 1500 –3000 mL). The average fol- low-up was 6.8 years (2–12 years). None of the patients experienced deterioration in their neurologic status after surgery. None of the patients had infection, pseudarthro- sis, or loss of correction during the follow-up visits. Conclusion. The simultaneous surgical treatment for congenital deformity and intraspinal abnormality does not involve significant complications and seems to be an alternative and safe treatment option. Key words: intraspinal abnormality, congenital scolio- sis, congenital kyphosis, surgical treatment. Spine 2007; 32:2880 –2884 Congenital scoliosis and/or kyphosis occurs as a result of either a failure of formation or a failure of segmentation, or both. 1 This most frequently occurs in the first 8 weeks of prenatal development. During this time, the bony ele- ments of the spine are forming, and the neuraxis is com- pleting its infolding, closing the neural tube. 2 These events are closely related, and any intrauterine event that causes congenital scoliosis and/or kyphosis could also be associated with an intraspinal anomaly. These anomalies include tethering of the cord, diastematomyelia, lipoma and lipomeningocele, teratomas, and syringomyelia. The intraspinal anomalies can cause progressive neu- ral loss with growth and curve progression. In addition, they greatly increase the risk of neurologic injury during surgical correction of the deformity. 3–6 McMaster 7 re- ported intraspinal abnormality in 18% of 251 patients with myelography. Magnetic resonance imaging (MRI) is noninvasive and more sensitive in detecting the in- traspinal abnormalities. Using MRI, Bradford et al 6 re- ported that 38% of the 42 patients in their study had an intraspinal anomaly. Congenital scoliosis and/or kyphosis due to the pres- ence of vertebral anomalies cause an imbalance in the longitudinal growth of the spine. Being a developmental anomaly, it is often associated with intraspinal, genito- urinary, cardiovascular, and other general abnormali- ties. 7–9 Congenital deformities of the spine are relatively rigid with a concurrent danger of neurologic complica- tions. 10 All these factors, including the presence of in- traspinal abnormalities, are important in decision- making and the management of congenital scoliosis. The classic advocated approach in such patients is first to perform surgery for the intraspinal pathologies and then surgery for correction and stabilization of the de- formity 3 to 6 months later. 7,9 To our knowledge, there is no study on simultaneous surgical treatment for these 2 associated conditions. In the current study, we have retrospectively analyzed 21 consecutive patients who underwent simultaneous surgical treatment for progressive spinal deformity and coexisting intraspinal pathologies (tethered cord and/or diastematomyelia). Materials and Methods We retrospectively reviewed the records of 21 consecutive pa- tients with congenital scoliosis and/or kyphosis associated with intraspinal abnormalities treated by simultaneous surgery be- tween the years 1994 and 2004. From the *Istanbul Bilim University Medical School, Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey; and †Istan- bul University Medical School Department of Orthopedics and Trau- matology, Istanbul, Turkey. Acknowledgment date: January 9, 2007. Revision date: May 5, 2007. Acceptance date: May 7, 2007. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Cagatay Ozturk, MD, Istanbul Bilim University, Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Caddesi, No: 290, 80220, Sisli, Istanbul, Turkey; E-mail: cgtyztrk@yahoo.com 2880