Ramírez Norman, Olivella Gerardo, Cuneo Alejandro, Carrazana Luis, Ramírez Nicole, Iriarte Iván
Pediatric Orthopedic Department, La Concepcion Hospital, San German Puerto Rico, PR, 00683, USA.
Transitional Residency Program, St. Luke's Episcopal Hospital, Ponce, PR, USA.
Spine Deform. 2020 Aug;8(4):663-668. doi: 10.1007/s43390-020-00065-w. Epub 2020 Feb 18.
Cross-sectional comparative study.
Evaluate prevalence and clinical relevance of an underlying pathology in painful adolescent idiopathic scoliosis (AIS) patients after a non-diagnostic history, physical examination and spinal X-ray using Magnetic Resonance Image (MRI) as diagnostic tool. Discrepancies regarding indications of routine MRI screening in painful AIS patients are multifactorial. Few studies have investigated relationship and practical importance of painful AIS with an underlying pathology by MRI.
A total of 152-consecutive AIS patients complaining of back pain during a 36-month period were enrolled. All patients underwent whole-spine MRI after a non-diagnostic history, physical examination and spinal X-ray. Underlying pathologies were reported as neural and non-neural axis abnormalities based on MRI reports. Variables such as sex, age, constant or intermittent pain, night pain, back pain location (thoracic or lumbar pain), Cobb-angle and follow-up were evaluated as clinical markers to predict presence of underlying MRI pathologies.
The presence of an underlying pathology was found by MRI in 54 painful AIS patients (35.5%). Isolated syringomyelia was the only neural axis abnormality found in 6 patients (3.9%). Non-neural axis abnormalities (31.6%) were composed by: 32 herniated nucleus pulposus, 5 vertebral disc desiccation, 4 ovarian cysts, 3 renal cysts, 2 sacral cysts, and 2 vertebral hemangiomas. There was no association with gender, age of presentation, initial coronal Cobb angle and follow up; with presence of an underlying pathology. Lumbar pain location was identified as an adequate clinical marker that correlated with presence of an underlying pathology (p = 0.01).
Prevalence of underlying pathologies diagnosed by MRI in painful AIS was found high (35.5%), but it's clinical relevance and implication are debatable. The use of MRI did not affect orthopedic management of painful AIS patients who showed an underlying pathology. A thorough evaluation must be performed by clinicians; and discussed with patients and family prior to undergo further imaging management.
Level III.
横断面比较研究。
在非诊断性病史、体格检查和脊柱X线检查后，使用磁共振成像（MRI）作为诊断工具，评估疼痛性青少年特发性脊柱侧凸（AIS）患者潜在病理状况的患病率及临床相关性。疼痛性AIS患者常规MRI筛查指征存在差异是多因素的。很少有研究通过MRI调查疼痛性AIS与潜在病理状况之间的关系及实际重要性。
纳入152例在36个月期间主诉背痛的连续性AIS患者。所有患者在非诊断性病史、体格检查和脊柱X线检查后均接受全脊柱MRI检查。根据MRI报告，将潜在病理状况报告为神经轴和非神经轴异常。将性别、年龄、持续性或间歇性疼痛、夜间疼痛、背痛部位（胸椎或腰椎疼痛）、Cobb角和随访等变量作为预测潜在MRI病理状况存在的临床指标进行评估。
54例疼痛性AIS患者（35.5%）通过MRI发现存在潜在病理状况。孤立性脊髓空洞症是6例患者（3.9%）中发现的唯一神经轴异常。非神经轴异常（31.6%）包括：32例椎间盘突出、5例椎间盘脱水、4例卵巢囊肿、3例肾囊肿、2例骶骨囊肿和2例椎体血管瘤。潜在病理状况的存在与性别、发病年龄、初始冠状位Cobb角和随访均无关联。腰椎疼痛部位被确定为与潜在病理状况存在相关的合适临床指标（p = 0.01）。
MRI诊断的疼痛性AIS患者潜在病理状况的患病率较高（35.5%），但其临床相关性和意义存在争议。MRI的使用并未影响显示有潜在病理状况的疼痛性AIS患者的骨科治疗。临床医生必须进行全面评估，并在进行进一步影像学检查之前与患者及其家属进行讨论。
三级。
