Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
Eur Spine J. 2019 Feb;28(2):421-425. doi: 10.1007/s00586-018-5522-3. Epub 2018 Feb 14.
Documents indicated that the average prevalence of intraspinal neural axis abnormalities (INAAs) in presumed idiopathic scoliosis (PIS) patients was about 17.7%. However, paucity study focuses on the incidence of INAAs in severe spinal deformity (SSDs). In this study, we investigate the incidence of intraspinal neural axis abnormalities (IINAAs) and the clinical relevance in SSD at a single center.
All the patients with SSDs admitted for spinal surgery were evaluated from 2003 to 2014.
patients who present with coronal Cobb over 90° (and/or the sagittal Cobb ≥ 90°); patients with whole spine magnetic resonance imaging (MRI) done preoperatively; and patients with documented clinical findings preoperatively.
ankylosing spondylitis, adult onset scoliosis, scoliosis secondary to bone destruction, and spinal dysraphism.
101 patients fulfilled the criteria were included. 43 patients were detected with INAAs (42.6%, 43/101). The most common INAAs was syrinx (S) (16/43, 37.2%). Of which, 43.7% (7/16), 37.5% (6/16), and 18.7% (3/16) were spindle, slit, and swelling types, respectively. Most of them were located in thoracic (6/16, 37.5%) and cervical (5/16, 31.3%) region. MRI revealed Chiari malformation with syringomyelia (C + S) in ten patients (10/43, 23.2%), Chiari malformation (C) in 6 patients (6/43, 13.9%) and others in 11 patients (11/43, 25.6%). As to the etiology, most patients with INAAs were PIS (34/43, 79.1%). On clinical examination, 16 of 101 patients (16/101, 15.8%) had abnormal neurologic signs. 15 of 16 patients (15/16, 93.7%) with abnormal neurologic signs had INAAs on MRI. On the other hand, 28 of 43 patients (28/43, 65.1%) with INAAs on MRI presented neurologically intact. 28 of 85 patients (28/85, 32.9%) with neurologically intact were detected with INAAs on MRI.
The incidence of INAAs in SSDs was 42.6%. 65.1% of them present intact neurologic status. The most common neural anomaly was syrinx. Preoperative whole spine MRI must be beneficial for SSDs even in the absence of neurological findings. These slides can be retrieved under Electronic Supplementary Material.
文献表明，特发性脊柱侧凸（PIS）患者的椎管内神经轴异常（INAAs）平均患病率约为 17.7%。然而，很少有研究关注严重脊柱畸形（SSDs）中 INAAs 的发病率。本研究旨在探讨单中心 SSD 中 INAAs 的发病率及临床相关性。
2003 年至 2014 年间，所有接受脊柱手术的 SSD 患者均接受评估。
冠状 Cobb 角＞90°（和/或矢状 Cobb≥90°）的患者；术前行全脊柱磁共振成像（MRI）检查的患者；术前有明确临床发现的患者。
强直性脊柱炎、成人脊柱侧凸、继发于骨破坏的脊柱侧凸和脊髓脊膜膨出。
101 例符合标准的患者被纳入研究。43 例患者（42.6%，43/101）存在 INAAs。最常见的 INAAs 是脊髓空洞症（S）（16/43，37.2%）。其中，纺锤型、裂隙型和肿胀型分别占 43.7%（7/16）、37.5%（6/16）和 18.7%（3/16）。大多数位于胸椎（6/16，37.5%）和颈椎（5/16，31.3%）区域。10 例（10/43，23.2%）患者 MRI 显示小脑扁桃体下疝伴脊髓空洞症（C+S），6 例（6/43，13.9%）患者 MRI 显示小脑扁桃体下疝（C），11 例（11/43，25.6%）患者其他部位异常。至于病因，大多数 INAAs 患者为特发性脊柱侧凸（34/43，79.1%）。临床检查发现，101 例患者中有 16 例（16/101，15.8%）存在神经异常体征。16 例中有 15 例（15/16，93.7%）存在 MRI 异常神经。另一方面，43 例 MRI 异常的患者中有 28 例（28/43，65.1%）表现为神经功能完整。85 例神经功能完整的患者中，有 28 例（28/85，32.9%）存在 MRI 异常。
SSD 中 INAAs 的发病率为 42.6%。其中 65.1%的患者神经功能完整。最常见的神经异常是脊髓空洞症。即使没有神经学发现，术前全脊柱 MRI 对 SSD 也有益。这些幻灯片可以在电子补充材料中找到。
