Scaramuzzo Laura, Giudici Fabrizio, Archetti Marino, Minoia Leone, Zagra Antonino, Bongetta Daniele
Spinal Division I, IRCCS Galeazzi Orthopedic Institute, Milan.
Department of Neurosurgery, IRCCS Policlinico S. Matteo Foundation.
Clin Spine Surg. 2019 May;32(4):E183-E187. doi: 10.1097/BSD.0000000000000820.
This was a prospective cohort study.
The main objectives of this study were to evaluate the prevalence and clinical relevance of neuroaxial anomalies in adolescent idiopathic scoliosis (AIS) patients as well as to evaluate different clinical and radiologic variables as potential predictors of the presence of a magnetic resonance imaging (MRI) abnormality.
The usefulness of preoperative magnetic resonance imaging in AIS is still debated in the literature as well as the clinical relevance of the neuroaxial anomalies detected.
We performed an analysis on 88 patients affected by AIS with normal neurological examination undergoing a posterior arthrodesis intervention. Patients were stratified according to the presence and type of neuroaxial abnormalities and were compared by age, sex, Risser grading, Lenke curve type, coronal and sagittal curve parameters, presence of alterations at intraoperative neuromonitoring, and "pain" and "function" scores at the SRS-22 test.
Neuroaxial abnormalities were reported in 23 patients (26.14%): 14 hydromyelias, 7 syringomyelias, 1 case of Chiari I syndrome, and 1 case of spinal ependymoma. Age, sex, Risser grading, curve type, and coronal and sagittal curve parameters did not differ between normal patients and patients with any neuroaxial abnormality. Alterations of motor-evoked potential/somatosensory-evoked potential monitoring during surgery were reported in 23 patients; the difference in their incidence between normal (20%) and hydromyelia (64%) patients was significant (P<0.01). In evaluating the subareas of the SRS-22 test, we found that the "function" scores differed significantly by comparing normal (21.5±1.6) and hydromyelia (20.4±1.8) patients (P<0.05).
The prevalence of neuroaxial abnormalities in AIS patients is relatively high, but we could not identify any definitive clinical or radiologic predictor of their presence. Hydromyelia was correlated with intraoperative motor-evoked potential/somatosensory-evoked potential electrophysiological alterations.
这是一项前瞻性队列研究。
本研究的主要目的是评估青少年特发性脊柱侧凸（AIS）患者中神经轴异常的患病率及临床相关性，以及评估不同的临床和放射学变量作为磁共振成像（MRI）异常存在的潜在预测指标。
术前MRI在AIS中的实用性以及所检测到的神经轴异常的临床相关性在文献中仍存在争议。
我们对88例接受后路融合手术且神经系统检查正常的AIS患者进行了分析。根据神经轴异常的存在情况和类型对患者进行分层，并比较其年龄、性别、Risser分级、Lenke曲线类型、冠状面和矢状面曲线参数、术中神经监测的改变情况以及SRS-22测试中的“疼痛”和“功能”评分。
23例患者（26.14%）报告有神经轴异常：14例脊髓空洞症、7例脊髓积水、1例Chiari I综合征和1例脊髓室管膜瘤。正常患者与有任何神经轴异常的患者在年龄、性别、Risser分级、曲线类型以及冠状面和矢状面曲线参数方面无差异。23例患者报告了手术期间运动诱发电位/体感诱发电位监测的改变；正常患者（20%）与脊髓空洞症患者（64%）之间其发生率的差异具有显著性（P<0.01）。在评估SRS-22测试的子区域时，我们发现正常患者（21.5±1.6）与脊髓空洞症患者（20.4±1.8）相比，“功能”评分有显著差异（P<0.05）。
AIS患者中神经轴异常的患病率相对较高，但我们无法确定其存在的任何明确的临床或放射学预测指标。脊髓空洞症与术中运动诱发电位/体感诱发电位电生理改变相关。
