Xu Wei, Zhang Xiangyang, Zhu Ying, Zhu Xiaodong, Li Zhikun, Li Dachuan, Jia Jianjun, Chen Liwei, Wang Silian, Bai Yushu, Li Ming
Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, People's Republic of China.
Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, People's Republic of China.
BMC Musculoskelet Disord. 2020 Mar 24;21(1):187. doi: 10.1186/s12891-020-3182-z.
Approximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis.
The clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student's t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher's exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities.
A total of 714 adolescent scoliosis patients with a mean age of 13.5 (10-18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P < 0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%, and the Youden index corresponding to the optimal critical point was 0.5519.
Risk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.
约80%的青少年脊柱侧弯病例为特发性，一些由脊髓异常引起的非特发性脊柱侧弯病例被误诊为特发性脊柱侧弯。本研究探讨了合并髓内异常的非特发性脊柱侧弯的危险因素，探索全脊柱MRI的可行性，为青少年特发性脊柱侧弯的常规诊疗提供理论依据。
回顾性分析2013年7月1日至2018年12月31日期间在上海同仁医院和上海长海医院收治的青少年脊柱侧弯患者的临床资料。根据全脊柱MRI结果，将患者分为特发性组和髓内异常组。比较两组患者的性别、年龄、主弯角度、主弯方向、后凸角度、脊柱侧弯类型、冠状面平衡、矢状面平衡、腹壁反射、感觉异常、踝阵挛和腱反射。采用Student's t检验评估连续变量的差异，采用卡方检验评估分类变量的差异。采用Fisher确切检验检测组间椎管内异常发生率的差异。采用Logistic回归评估多因素危险因素与髓内异常的相关性。
本研究共纳入714例平均年龄为13.5岁（10 - 18岁）的青少年脊柱侧弯患者，其中68例（9.5%）发现髓内异常。男女之间、左右胸弯之间、角状脊柱侧弯和平滑脊柱侧弯之间以及腹壁反射异常和踝阵挛之间的髓内异常发生率存在统计学显著差异（P < 0.01）。Logistic回归显示，性别、脊柱侧弯方向、脊柱侧弯类型、腹壁反射和踝阵挛的比值分别为2.987、3.493、4.823、3.94和8.083。ROC曲线显示敏感性为66.18%，特异性为89.01%，对应最佳临界点的约登指数为0.5519。
与青少年髓内异常所致脊柱侧弯相关的危险因素包括男性、左侧胸段脊柱侧弯、脊柱急剧弯曲、腹壁反射异常和踝阵挛。在青少年脊柱侧弯患者中，髓内异常所致脊柱侧弯的发生率约为9.5%。这些临床指标提示存在高危青少年脊柱侧弯人群，术前应行全脊柱MRI以排除髓内异常。
