Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, University Medical Center Utrecht, P.O.Box 85500, 3508 GA, Utrecht, The Netherlands.
Spine J. 2018 Jul;18(7):1261-1271. doi: 10.1016/j.spinee.2018.02.013. Epub 2018 Feb 14.
There is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies that could complicate deformity surgery. However, routine MRI increases health-care costs significantly and may reveal mild variations from normal findings without clinical relevance, which can still lead to anxiety and influence decision-making.
Given the necessity to make evidence-based decisions both in the light of quality of care and cost control, the aim of this review is to report the prevalence of neural axis anomalies in IS and to identify risk factors associated with these anomalies.
A systematic review was carried out.
An electronic search of PubMed, Embase, Cochrane, and Cinahl until May 2017 was performed. Studies were assessed by two reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (diagnosis other than IS).
Fifty-one studies were included comprising 8,622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalence was 10.5%, 9.0%, and 14.2% when screening was performed of all IS patients, preoperative patients, or patients with presumed risk factors. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%), or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%), and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early-onset scoliosis, male gender, atypical curves, thoracic kyphosis, and abnormal neurologic findings such as reflexes and sensation.
This systematic review shows that a significant number of patients have intraspinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in preselected patient groups with specific risk factors.
对于特发性脊柱侧凸（IS）患者，术前常规使用磁共振成像（MRI）存在争议。常规 MRI 有助于确定畸形的可能原因，并发现可能使畸形手术复杂化的异常。然而，常规 MRI 会显著增加医疗保健成本，并且可能会发现与正常发现轻度不同但无临床意义的变化，这仍然会导致焦虑并影响决策。
鉴于在关注护理质量和成本控制的情况下做出基于证据的决策的必要性，本综述的目的是报告 IS 中神经轴异常的发生率，并确定与这些异常相关的危险因素。
进行了系统评价。
对 PubMed、Embase、Cochrane 和 Cinahl 进行了电子检索，检索时间截至 2017 年 5 月。根据预定的纳入（疑似 IS 的 MRI）和排除标准（非 IS 诊断），由两名评审员独立评估研究。
共纳入 51 项研究，包括 8622 例患者。在 981 例患者中发现了异常，总体发生率为 11.4%。在筛查所有 IS 患者、术前患者或疑似危险因素患者时，患病率分别为 10.5%、9.0%和 14.2%。最常见的诊断是脊髓空洞症（3.7%）、Arnold-Chiari 畸形（3.0%）或两者兼而有之（2.5%）。较少见的诊断包括脊髓栓系（0.6%）、偶然发现的恶性肿瘤（0.3%）和脊髓分裂畸形（0.2%）。脊柱内异常的危险因素包括早发性脊柱侧凸、男性、非典型曲线、胸椎后凸和反射和感觉等异常神经学发现。
本系统评价表明，术前 MRI 显示（疑似）IS 患者中有相当数量的患者存在脊柱内异常。在具有特定危险因素的预选患者组中，发现脊柱轴异常的患病率增加。
