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Myelodysplasia with attendant spinal dysraphic disorders can be and often is progressive. In addition to the neurologic deficit present since the prenatal period, hydrocephalus, Chiari malformations with hydromyelia, tethered cord syndrome, or combinations of one or all lead to changing functional ability and progressive deformities. With recent advances in neurologic monitoring and treatment, many of these deformities can be prevented from appearing or becoming destabilizing if the subtle signs are picked up and early intervention is provided. Advances in urologic surgery have also provided better control of continence in addition to reduced infections and renal destruction. This article reviews the monitoring and treatment considerations that have led to such a significant improvement in outcomes in patients who have myelodysplasia.

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Although there may be a hereditary component to true idiopathic scoliosis, the condition has no known cause and is not associated with dysraphism. However, scoliosis with an associated syrinx, with or without the Chiari I malformation, sometimes presents as an idiopathic-type curve. Physical examination findings and subtle clues on diagnostic imaging may help the orthopaedic surgeon diagnose scoliosis associated with syringomyelia. Examination findings include asymmetric reflexes and presentation at ages younger than those of patients who present with adolescent idiopathic curves (i.e., 10 to 14 years). Radiologic findings include kyphosis at the apex of the curve. Indications for surgical decompression include progressive neurologic deficits, weakness, pain, and progressive curves. Most orthopaedic surgeons agree that a syrinx should be evaluated neurosurgically before any planned spinal arthrodesis to decrease the risk of neurologic injury connected with surgical correction. The indications for arthrodesis in these patients compared with those with idiopathic curves are evolving.

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BACKGROUND: Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns. The scientific evidence supporting the use chiropractic intervention is inadequate. The purpose of this study was to conduct a pilot study and explore issues of safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, inter-professional cooperation, quality assurance, and outcome measure selection. METHODS: Six patients participated in this 6-month study, 5 of whom were female. One female was braced. The mean age of these patients was 14 years, and the mean Cobb angle was 22.2 degrees. The study design was a randomized controlled clinical trial with two independent and blinded observers. Three patients were treated by standard medical care (observation or brace treatment), two were treated with standard medical care plus chiropractic manipulation, and one was treated with standard medical care plus sham manipulation. The primary outcome measure was Cobb, and the psychosocial measure was Scoliosis Quality of Life Index. RESULTS: Orthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial. Patient recruitment and compliance was good. Chiropractic treatments were safely employed, and research protocols were successful. CONCLUSION: Overall, our pilot study showed the viability for a larger randomized trial. This pilot confirms the strength of existing protocols with amendments for use in a full randomized controlled trial. TRIAL REGISTRATION: This trial has been assigned an international standard randomized controlled trial number by Current Controlled Trials, Ltd. http://www.controlled-trials.com/isrctn/. The number is ISRCTN41221647.

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