Fruergaard Sidsel, Ohrt-Nissen Søren, Dahl Benny, Kaltoft Nicolai, Gehrchen Martin
Department of Orthopedic Surgery, Spine Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Orthopaedic Surgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA.
Neurospine. 2019 Jun;16(2):339-346. doi: 10.14245/ns.1836154.077. Epub 2018 Oct 15.
Magnetic resonance imaging (MRI)-verified neural axis abnormalities (NAAs) have been described in adolescent idiopathic scoliosis (AIS), and several risk factors have been associated with the presence of NAAs in AIS patients. However, the clinical significance of these findings is unclear. The purpose of the present study was to determine the prevalence of NAAs in a large consecutive cohort of AIS patients and to evaluate the clinical significance of previously proposed risk factors.
We prospectively included AIS patients referred to a tertiary facility for evaluation. Full-spine MRI scans were performed on all included patients irrespective of curve magnitude or proposed treatment modality. MRI scans were prospectively analyzed by a neuroradiologist and the pathologic findings were confirmed by a second independent radiologist.
NAA was observed in 34 of the 381 patients (8.9%): 32 patients had a syrinx, 1 patient had an arachnoid cyst, and 1 patient had a Chiari malformation. Four patients were referred for a neurosurgical evaluation but none received any neurosurgical treatment. No statistically significant difference was observed between the NAA and non-NAA groups in terms of sex, major curve size, thoracic kyphosis, left thoracic curve, curve convexity, curve progression, or level of pain (p>0.05).
In this prospective study examining the risk factors for NAA in AIS patients, we found that previously proposed risk factors could not predict the MRI outcomes. The finding of an NAA had no clinical implications and we do not support MRI scans as a routine diagnostic modality in all AIS patients.
青少年特发性脊柱侧凸（AIS）患者中已发现经磁共振成像（MRI）证实的神经轴异常（NAA），且多种危险因素与AIS患者出现NAA有关。然而，这些发现的临床意义尚不清楚。本研究的目的是确定一大组连续AIS患者中NAA的患病率，并评估先前提出的危险因素的临床意义。
我们前瞻性纳入了转诊至三级医疗机构进行评估的AIS患者。对所有纳入患者均进行全脊柱MRI扫描，无论其侧弯度数或建议的治疗方式如何。由一名神经放射科医生对MRI扫描结果进行前瞻性分析，并由另一名独立放射科医生确认病理结果。
381例患者中有34例（8.9%）观察到NAA：32例患者有脊髓空洞症，1例患者有蛛网膜囊肿，1例患者有Chiari畸形。4例患者被转诊进行神经外科评估，但均未接受任何神经外科治疗。NAA组和非NAA组在性别、主弯大小、胸椎后凸、左侧胸弯、侧弯凸度、侧弯进展或疼痛程度方面未观察到统计学显著差异（p>0.05）。
在这项对AIS患者NAA危险因素的前瞻性研究中，我们发现先前提出的危险因素无法预测MRI结果。NAA的发现没有临床意义，我们不支持对所有AIS患者进行MRI扫描作为常规诊断手段。
