Qiu Yong, Zhu Zezhang, Wang Bin, Yu Yang, Qian Bangping, Zhu Feng
Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
J Pediatr Orthop. 2008 Jan-Feb;28(1):128-33. doi: 10.1097/bpo.0b013e31815ff371.
Few radiographic guidelines are available to assist clinicians in deciding when to order magnetic resonance imaging in patients with a normal history and physical examination. Most of the recent reports on the radiographic characteristics of scoliosis are limited by a small number of patients and a shortage of large curves. The association between radiological features and the severity of scoliosis has little been elaborated. The purpose of this study is to further explore the radiological presentations in relation to curve severity in scoliosis associated with Chiari malformation and syringomyelia.
A total of 87 children and adolescents were divided into 3 groups: group 1 (10 degrees < or = Cobb angle < or = 30 degrees), group 2 (30 degrees < Cobb angle < or = 60 degrees), and group 3 (Cobb angle > 60 degrees). Curves were classified into typical and atypical patterns in the coronal plane, and the sagittal profile was measured. Cerebellar tonsillar descent or syrinx patterns in relation to curve severity and the frequency of atypical curves were also investigated.
The frequency of atypical curve patterns from groups 1 to 3 was 46.2%, 45.2%, and 40.7%, respectively. A total of 65.3% of patients with typical curve patterns had atypical features in all of the 3 groups. There was a significant difference of kyphotic angle among the 3 groups showing that the larger curves tended to have greater thoracic kyphosis. Both the degree of cerebellar tonsillar descent and syrinx patterns had no correlation with the curve severity or the frequency of atypical curves.
These results show that radiographic presentations including atypical curve patterns, atypical features in typical curve patterns, and a normal to hyperkyphotic thoracic spine may suggest the need for a preoperative magnetic resonance imaging. Kyphosis may be indicative of progressive scoliosis. There is no evidence to suggest that the degree of cerebellar tonsillar descent and syrinx patterns have an effect on the progress of scoliosis and the frequency of atypical curves.
几乎没有影像学指南可协助临床医生决定在病史和体格检查正常的患者中何时进行磁共振成像检查。近期关于脊柱侧凸影像学特征的大多数报告受到患者数量少和大弯病例缺乏的限制。放射学特征与脊柱侧凸严重程度之间的关联很少得到阐述。本研究的目的是进一步探讨与Chiari畸形和脊髓空洞症相关的脊柱侧凸中与曲线严重程度相关的放射学表现。
总共87名儿童和青少年被分为3组：第1组（Cobb角10度≤或＜30度），第2组（Cobb角30度＜或≤60度），第3组（Cobb角＞60度）。曲线在冠状面被分为典型和非典型模式，并测量矢状面轮廓。还研究了与曲线严重程度相关的小脑扁桃体下移或脊髓空洞模式以及非典型曲线的频率。
第1组至第3组非典型曲线模式的频率分别为46.2%、45.2%和40.7%。在所有3组中，共有65.3%具有典型曲线模式的患者具有非典型特征。3组之间的后凸角存在显著差异，表明较大的曲线往往具有更大的胸椎后凸。小脑扁桃体下移程度和脊髓空洞模式均与曲线严重程度或非典型曲线的频率无关。
这些结果表明，包括非典型曲线模式、典型曲线模式中的非典型特征以及正常至过度后凸的胸椎在内的放射学表现可能提示术前需要进行磁共振成像检查。后凸可能提示进行性脊柱侧凸。没有证据表明小脑扁桃体下移程度和脊髓空洞模式对脊柱侧凸的进展和非典型曲线的频率有影响。
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