Abul-Kasim Kasim, Overgaard Angelica, Karlsson Magnus K, Ohlin Acke
Lund University, Sweden.
Scoliosis. 2009 Nov 12;4:25. doi: 10.1186/1748-7161-4-25.
There is an ongoing controversy about the significance of tonsillar ectopia among patients with idiopathic scoliosis (IS).
To find out if tonsillar ectopia occurs more frequently among patients with IS and if it plays any etiological or prognostic role in IS.
Retrospective study.
Retrospective analysis of 155 consecutive spine MRIs (79 patients with IS and 76 controls; aged 7-25 years; 55% were female) with regard to the position of the cerebellar tonsils in relation to foramen magnum and the sagittal diameter of foramen magnum. All images were evaluated independently by two neuroradiologists. Interobserver and intraobserver reliability analysis was performed by calculation of kappa-value, intraclass correlation coefficient, and systematic and random errors. The occurrence of tonsillar ectopia among patients with IS and controls was estimated and the association of tonsillar ectopia with different predictors has been tested. Statistical significance was set to P < or = 0.05.
The interobserver and intraobserver agreement with regard to the occurrence of tonsillar ectopia was almost perfect (kappa 0.84 and 0.89, respectively). Tonsillar ectopia was found in 37% of patients with IS compared with 13% among controls (p < 0.001 and odds ratio of 3.8, 95% CI 1.7-8.5). The occurrence of tonsillar ectopia was not associated with the severity of scoliotic deformity (p = 0.85), or rapid progression of scoliosis (p = 0.76). Neurological deficit occurs twice as frequently in patients with tonsillar ectopia as in those with no tonsillar ectopia. Two of five patients with tonsillar ectopia showed improvement of their neurological deficit after the surgical correction of scoliosis.
As tonsillar ectopia is significantly more frequent among patients with IS and may exhibit some prognostic utility in patients with neurological deficit, we forward the hypothesis that tonsillar ectopia may play a role in the development of the deformity in some patients with IS. However, occurrence of tonsillar ectopia among 13% of controls precludes stating a definitive role of tonsillar ectopia in the pathogenesis of IS. Some patients with IS, tonsillar ectopia and neurological deficit showed neurological improvement following the surgical correction of scoliosis.
关于特发性脊柱侧凸（IS）患者中扁桃体异位的意义一直存在争议。
探究扁桃体异位在IS患者中是否更频繁发生，以及它在IS中是否起任何病因学或预后作用。
回顾性研究。
对155例连续的脊柱磁共振成像（79例IS患者和76例对照；年龄7 - 25岁；55%为女性）进行回顾性分析，观察小脑扁桃体相对于枕骨大孔的位置以及枕骨大孔的矢状径。所有图像由两名神经放射科医生独立评估。通过计算kappa值、组内相关系数以及系统误差和随机误差进行观察者间和观察者内可靠性分析。评估IS患者和对照组中扁桃体异位的发生率，并测试扁桃体异位与不同预测因素的关联。设定统计学显著性为P≤0.05。
观察者间和观察者内关于扁桃体异位发生率的一致性几乎完美（kappa值分别为0.84和0.89）。37%的IS患者发现有扁桃体异位，而对照组为13%（p < 0.001，优势比为3.8，95%可信区间为1.7 - 8.5）。扁桃体异位的发生与脊柱侧凸畸形的严重程度无关（p = 0.85），也与脊柱侧凸的快速进展无关（p = 0.76）。有扁桃体异位的患者神经功能缺损的发生率是无扁桃体异位患者的两倍。5例有扁桃体异位的患者中有2例在脊柱侧凸手术矫正后神经功能缺损得到改善。
由于扁桃体异位在IS患者中明显更常见，并且在有神经功能缺损的患者中可能具有一定的预后价值，我们提出假说，扁桃体异位可能在一些IS患者的畸形发展中起作用。然而，13%的对照组中也存在扁桃体异位，这使得无法明确扁桃体异位在IS发病机制中的作用。一些患有IS、扁桃体异位和神经功能缺损的患者在脊柱侧凸手术矫正后神经功能得到改善。
