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. 2019 Jun;16(2):339-346.
doi: 10.14245/ns.1836154.077. Epub 2018 Oct 15.

Neural Axis Abnormalities in Patients With Adolescent Idiopathic Scoliosis: Is Routine Magnetic Resonance Imaging Indicated Irrespective of Curve Severity?

Sidsel Fruergaard  1 , Søren Ohrt-Nissen  1 , Benny Dahl  2 , Nicolai Kaltoft  3 , Martin Gehrchen  1
Affiliations

Neural Axis Abnormalities in Patients With Adolescent Idiopathic Scoliosis: Is Routine Magnetic Resonance Imaging Indicated Irrespective of Curve Severity?

Sidsel Fruergaard et al. Neurospine. 2019 Jun.

Abstract

Objective: Magnetic resonance imaging (MRI)-verified neural axis abnormalities (NAAs) have been described in adolescent idiopathic scoliosis (AIS), and several risk factors have been associated with the presence of NAAs in AIS patients. However, the clinical significance of these findings is unclear. The purpose of the present study was to determine the prevalence of NAAs in a large consecutive cohort of AIS patients and to evaluate the clinical significance of previously proposed risk factors.

Methods: We prospectively included AIS patients referred to a tertiary facility for evaluation. Full-spine MRI scans were performed on all included patients irrespective of curve magnitude or proposed treatment modality. MRI scans were prospectively analyzed by a neuroradiologist and the pathologic findings were confirmed by a second independent radiologist.

Results: NAA was observed in 34 of the 381 patients (8.9%): 32 patients had a syrinx, 1 patient had an arachnoid cyst, and 1 patient had a Chiari malformation. Four patients were referred for a neurosurgical evaluation but none received any neurosurgical treatment. No statistically significant difference was observed between the NAA and non-NAA groups in terms of sex, major curve size, thoracic kyphosis, left thoracic curve, curve convexity, curve progression, or level of pain (p>0.05).

Conclusion: In this prospective study examining the risk factors for NAA in AIS patients, we found that previously proposed risk factors could not predict the MRI outcomes. The finding of an NAA had no clinical implications and we do not support MRI scans as a routine diagnostic modality in all AIS patients.

Keywords: Adolescent idiopathic scoliosis; Magnetic resonance imaging; Neural axis abnormality; Syringomyelia; Syrinx.

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Conflict of interest statement

Benny Dahl received institutional grants from K2M and MEDTRONIC outside the submitted work. Martin Gehrchen received institutional grants from K2M and MEDTRONIC outside the submitted work. Sidsel Fruergaard received institutional grants from MEDTRONIC. Søren Ohrt-Nissen received institutional grants from K2M outside the submitted work. The other authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Inclusion process. AIS, adolescent idiopathic scoliosis; MRI, magnetic resonance imaging; NAA, neural axis abnormality.
Fig. 2.
Fig. 2.
Magnetic resonance imaging with 1.5 Tesla Scanner, sagittal T2-weighted from a patient with a thoracic syrinx (arrow).
Fig. 3.
Fig. 3.
Proposed risk factors for neural axis abnormalities (NAAs) in adolescent idiopathic scoliosis. TK, thoracic kyphosis; APR, annual progression rate; Atypical, left side thoracic curve.
See this image and copyright information in PMC

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