Swarup Ishaan, Silberman Jason, Blanco John, Widmann Roger
Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
Spine Deform. 2019 Jan;7(1):47-52. doi: 10.1016/j.jspd.2018.06.006.
Retrospective study with follow-up.
The purpose of this study was to determine the incidence of intraspinal and extraspinal MRI abnormalities in a consecutive series of patients with adolescent idiopathic scoliosis (AIS) and to describe the evaluation and management of these abnormalities.
Indications for preoperative magnetic resonance imaging (MRI) in patients with AIS remain controversial. Previous studies have reported a wide range of abnormality rates; however, the majority of these studies focus on a nonconsecutive series of patients, and none of these studies report the incidence of extraspinal abnormalities.
We studied a consecutive series of patients with AIS managed with spinal deformity surgery. All patients underwent a routine neural axis MRI prior to surgery. MRI reports were reviewed, and intraspinal and extraspinal abnormalities were recorded. Additional chart review and follow-up was performed to determine the rates of evaluation and management for these abnormalities. Descriptive statistics were used to describe the incidence and types of abnormalities, as well as the rates of evaluation and management.
This study included a consecutive series of 259 patients with AIS. MRI abnormalities were noted in 115 patients (44%). After excluding patients with degenerative changes, MRI abnormalities were noted in 64 patients (25%). The incidence of Chiari malformation was 4.2% and syringomyelia was 5%. Extraspinal abnormalities were noted in 10% of patients, and these findings ranged from benign cysts to malignant soft tissue tumor. Approximately 10% of patients needed additional evaluation because of their preoperative MRI findings, and 0.7% of patients required surgical management prior to spinal deformity surgery.
Significant MRI abnormalities were noted in patients with AIS, and some patients required further evaluation prior to surgery. Additional study including cost-effectiveness analysis is needed to better define the role of preoperative MRI in patients with AIS.
Level II.
随访的回顾性研究。
本研究旨在确定青少年特发性脊柱侧凸（AIS）连续系列患者脊柱内和脊柱外MRI异常的发生率，并描述这些异常的评估和管理。
AIS患者术前磁共振成像（MRI）的指征仍存在争议。既往研究报道的异常率范围广泛；然而，这些研究大多集中在非连续系列患者，且均未报告脊柱外异常的发生率。
我们研究了接受脊柱畸形手术治疗的AIS连续系列患者。所有患者在手术前均接受常规神经轴MRI检查。回顾MRI报告，记录脊柱内和脊柱外异常情况。进行额外的病历审查和随访，以确定这些异常的评估和管理率。采用描述性统计来描述异常的发生率和类型，以及评估和管理率。
本研究纳入了259例AIS连续系列患者。115例患者（44%）发现MRI异常。排除退行性改变患者后，64例患者（25%）发现MRI异常。Chiari畸形的发生率为4.2%，脊髓空洞症为5%。10%的患者发现脊柱外异常，这些发现范围从良性囊肿到恶性软组织肿瘤。约10%的患者因术前MRI检查结果需要进一步评估，0.7%的患者在脊柱畸形手术前需要手术治疗。
AIS患者中发现了显著的MRI异常，部分患者在手术前需要进一步评估。需要进行包括成本效益分析在内的更多研究，以更好地明确术前MRI在AIS患者中的作用。
二级。
