Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2021;41(10):585-590. doi: 10.1097/BPO.0000000000001943.
Patients with adolescent idiopathic scoliosis (AIS) are commonly monitored for curve progression with spinal radiographs; however, the utility of magnetic resonance imaging (MRI) screening is unclear. The purpose of this study was to assess the findings of screening MRI for patients with a nonsurgical curve size ordered during routine clinical care and compare them with MRI ordered for patients with large curves as part of preoperative screening.
All consecutive patients with presumed AIS who underwent entire-spine MRI with a presumed diagnosis of idiopathic scoliosis at a single institution between 2017 and 2019 were retrospectively reviewed. Patients were stratified based on MRI indication into the following groups: preoperative evaluation, pain, neurological symptoms, abnormal radiographic curve appearance, rapidly progressive curve, and other. Neural axis abnormalities recorded included concern for tethered spinal cord, syringomyelia, and Chiari malformation. The MRI findings of preoperative patients with large curves were compared with all other patients. The number needed to diagnose (NND) a neurological finding was calculated in patients whose MRIs were ordered during routine clinical care. The amount charged for each patient undergoing entire-spine MRI was determined by review of our institution's Financial Decision Support system.
There were 344 patients included in this study with 214 (62%) MRIs performed for preoperative evaluation. Although MRI abnormalities were found in 49% of patients, only 7.0% (24/344) demonstrated neural axis abnormalities with no difference between preoperative and other indications (P=0.37). For patients with nonsurgical curves undergoing MRI due to a complaint of back pain (n=28), there were no neural axis abnormalities, and a lower rate of disk herniation/degenerative changes detected compared with preoperative MRI (3.6% vs. 18%, P=0.06). Among the 15 patients undergoing MRI for a neurological concern, 1 had a neural axis abnormality that required surgical detethering. The NND for MRI to detect a neural axis abnormality that potentially required neurosurgical intervention in nonpreoperative patients with a neurological concern was 34.4. The average cost for MRI was $17,816 (range: $2601 to $22,411) with a total cost of $2,368,439 for nonsurgical curves.
Entire-spine MRI for nonpreoperative indications including pain, abnormal radiographic curve appearance, and rapid curve progression has minimal utility for patients with AIS. For patients with neurological complaints, the NND a potentially treatment-altering finding with MRI is 34.4.
Level II-diagnostic.
青少年特发性脊柱侧凸（AIS）患者通常通过脊柱 X 光片监测曲线进展情况；然而，磁共振成像（MRI）筛查的效用尚不清楚。本研究的目的是评估在常规临床护理中对非手术曲线大小进行排序的患者进行筛查性 MRI 的结果，并将其与作为术前筛查一部分对大曲线进行排序的患者的 MRI 结果进行比较。
对 2017 年至 2019 年间在一家机构接受整个脊柱 MRI 检查且疑似特发性脊柱侧凸的所有连续疑似 AIS 患者进行回顾性分析。根据 MRI 检查的目的，患者分为以下组：术前评估、疼痛、神经症状、异常放射曲线外观、快速进展性曲线和其他。记录的神经轴异常包括对脊髓拴系、脊髓空洞症和 Chiari 畸形的担忧。比较了术前大曲线患者的 MRI 检查结果与所有其他患者。在常规临床护理中对 MRI 进行排序的患者中，计算出诊断出神经学发现所需的数量（NND）。通过审查我们机构的财务决策支持系统确定每位接受整个脊柱 MRI 检查的患者的费用。
本研究共纳入 344 例患者，其中 214 例（62%）患者因术前评估而行 MRI 检查。尽管在 49%的患者中发现了 MRI 异常，但仅在 7.0%（24/344）的患者中发现了神经轴异常，且术前和其他指征之间无差异（P=0.37）。对于因背痛而接受 MRI 检查的非手术性脊柱侧凸患者（n=28），无神经轴异常，与术前 MRI 检查相比，椎间盘突出/退行性改变的发生率较低（3.6% vs. 18%，P=0.06）。在 15 例因神经学问题而接受 MRI 检查的患者中，有 1 例神经轴异常需要神经外科松解。对于有神经学问题的非手术患者，MRI 检测到可能需要神经外科干预的神经轴异常的 NND 为 34.4。MRI 的平均费用为 17816 美元（范围：2601 美元至 22411 美元），非手术性脊柱侧凸的总费用为 2368439 美元。
包括疼痛、异常放射曲线外观和快速曲线进展在内的非术前指征的全脊柱 MRI 对 AIS 患者的用处不大。对于有神经学症状的患者，MRI 检查出潜在的治疗改变的 NND 为 34.4。
II 级诊断。
