Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Spine (Phila Pa 1976). 2011 Apr 15;36(8):667-71. doi: 10.1097/BRS.0b013e3181da218c.
Multicenter, prospective, consecutive clinical series. OBJECTIVE.: To report on the use and outcomes of preoperative magnetic resonance imaging (MRI) in a prospective cohort study of 2206 children undergoing posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.
There is no consensus on the use of MRI in the preoperative evaluation of children with idiopathic scoliosis. Also, there is no consensus on the rate of abnormality and the relevance of abnormality on surgical outcome in so-called "idiopathic" scoliosis.
We reviewed the first 2206 patients entered consecutively into the Prospective Pediatric Scoliosis Study, a database of children (8-18 years) undergoing operation for scoliosis by pediatric spinal surgeons in the Spinal Deformity Study Group.
There were 1812 girls (80.8%) and 394 boys (17.5%). Mean age at operation was 14 years and 3 months. A total of 191 (8.6%) had juvenile idiopathic scoliosis (age ≤ 10 years). A total of 923 patients (41.8%) underwent spine MRI. Ninety-one abnormalities of the spine were detected (9.9% of the 923 screened), of which 39 (4.2%) were neural. There were 26 syringes (66.7% of neural abnormalities and 28.6% of all abnormalities), 12 Chiari malformations (30.7% and 13.2%, respectively), and 1 tethered cord (2.6% and 1.1%, respectively). Fifty-three patients (5.7%) demonstrated abnormalities affecting "other" parts of the spine than the neural elements. Patients undergoing MRI more frequently had a thoracic hyperkyphosis (P < 0.001), had a diagnosis of juvenile idiopathic scoliosis (P < 0.001), had a Risser grade between 0 and 2 (P = 0.022), had a greater curve magnitude (P < 0.001), had three major curves (P < 0.001), were male (P = 0.004), and underwent a combined anterior-posterior surgical approach (P < 0.001). Thoracic hyperkyphosis and juvenile onset were associated with greater chance of neural lesion on MRI of the spine. Incidence of abnormal MRI did not differ significantly by direction of apex, Risser grade, curve magnitude or type, male sex, or body mass index.
Use of preoperative MRI was 41.8%; 9.9% of patients with so-called "idiopathic" scoliosis had an abnormality on MRI, of which 4.2% were neural anomalies. Of these, syrinx was 66.7%, Chiari was 30.7%, and tethered cord was 2.6%. Significant risk factors for neural abnormality were thoracic hyperkyphosis and juvenile onset. Other characteristics, including apex left thoracic curve, Risser less than or equal to 1, large curve magnitude, triple major curve, male sex, and obesity were not associated with neural abnormality. There were no differences in complication rates between normal and abnormal MRI patients. Our data question the routine use of MRI as a screening tool for adolescent idiopathic scoliosis.
多中心、前瞻性、连续临床系列。目的：报告 2206 例青少年特发性脊柱侧凸后路脊柱融合内固定术患者前瞻性队列研究中术前磁共振成像（MRI）的使用情况和结果。
对于特发性脊柱侧凸患儿的术前评估，MRI 的使用尚无共识。此外，在所谓的“特发性”脊柱侧凸中，异常的发生率以及异常对手术结果的相关性也尚无共识。
我们回顾了连续纳入特发性脊柱侧凸前瞻性儿科研究数据库的前 2206 例患者，这是一个由小儿脊柱外科医生在脊柱畸形研究组中对脊柱侧凸患儿进行手术的数据库。
1812 例为女孩（80.8%），394 例为男孩（17.5%）。手术时平均年龄为 14 岁零 3 个月。共有 191 例（8.6%）为青少年特发性脊柱侧凸（年龄≤10 岁）。共有 923 例患者（41.8%）接受了脊柱 MRI。共发现 91 例脊柱异常（923 例筛查中 9.9%），其中 39 例（4.2%）为神经异常。有 26 例脊髓空洞症（神经异常的 66.7%，所有异常的 28.6%），12 例 Chiari 畸形（分别为 30.7%和 13.2%），1 例脊髓栓系（分别为 2.6%和 1.1%）。53 例（5.7%）患者存在“其他”脊柱部位异常，而非神经异常。接受 MRI 的患者更常出现胸椎后凸过度（P<0.001），诊断为青少年特发性脊柱侧凸（P<0.001），Risser 分级为 0-2（P=0.022），侧弯更大（P<0.001），存在三个主要曲线（P<0.001），为男性（P=0.004），并采用前后联合手术方法（P<0.001）。胸椎后凸过度和青少年发病与脊柱 MRI 神经病变的几率增加有关。异常 MRI 的发生率与顶椎方向、Risser 分级、曲线大小或类型、性别或 BMI 无显著差异。
术前 MRI 的使用率为 41.8%；所谓“特发性”脊柱侧凸患者中有 9.9%在 MRI 上存在异常，其中 4.2%为神经异常。其中，脊髓空洞症为 66.7%，Chiari 畸形为 30.7%，脊髓栓系为 2.6%。神经异常的显著危险因素为胸椎后凸过度和青少年发病。其他特征，包括左胸主弯、Risser 分级≤1、大的侧弯程度、三主弯、男性和肥胖，与神经异常无关。正常 MRI 和异常 MRI 患者的并发症发生率无差异。我们的数据对常规使用 MRI 作为青少年特发性脊柱侧凸的筛查工具提出了质疑。
