Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA.
Spine Deform. 2023 Jan;11(1):95-104. doi: 10.1007/s43390-022-00568-8. Epub 2022 Aug 30.
The purpose of this study was to use a Delphi analysis to identify a clinically relevant threshold for the prevalence of neural axis abnormalities (NAAs) that would warrant routine preoperative screening.
A panel of experienced physicians specializing in pediatric spine surgery, pediatric neurosurgery, and pediatric neuroradiology was formed to establish consensus using a Delphi process to identify a minimum prevalence of NAAs that would initiate the implementation of preoperative MRIs as standard of care. Following the Delphi analysis, patients scheduled for PSF (Posterior Spinal Fusion) from 2010 to 2018 were retrospectively identified. Patients were included based on the following criteria: (1) 10-18 years old at time of MRI (inclusive), (2) AIS diagnosis prior to preoperative MRI (no concerning curve pattern, rate of progression, or neurologic signs/symptoms to suggest alternative diagnosis to AIS), and (3) standard preoperative MRI of the cervical, thoracic, and lumbar spine undergone. The prevalence of NAAs on preoperative MRI was recorded for all patients.
There were 182 eligible patients. 14 had NAAs on MRI. The prevalence of NAAs was 7.7% [95% CI 4.27-12.57%]. This prevalence was significantly [p < 0.0001] higher than the clinically relevant threshold of 1.3% established by the Delphi panel. Of the 14 patients with NAAs noted on preoperative MRI, neurosurgical intervention was recommended for 4 patients, 2.2% [95% CI 0.6-5.5%] of the total cohort.
Delphi panelists reported a low tolerance for NAAs among patients undergoing PSF for presumed AIS. Group consensus recommended routine screening should be implemented if the prevalence of NAAs is greater than 1.3%. The prevalence of NAAs in our cohort as well as related studies was significantly higher than this threshold.
Diagnostic-level III.
本研究旨在通过德尔菲分析确定一个与临床相关的神经轴异常（NAA）患病率阈值，以便常规进行术前筛查。
组建了一个由专门从事小儿脊柱外科、小儿神经外科和小儿神经放射学的经验丰富的医生组成的小组，通过德尔菲法达成共识，以确定一个最小的 NAA 患病率，该患病率将启动将术前 MRI 作为标准护理。在德尔菲分析之后，回顾性地确定了 2010 年至 2018 年期间接受 PSF（后路脊柱融合术）的患者。根据以下标准纳入患者：（1）在 MRI 时年龄为 10-18 岁（含），（2）术前 MRI 有 AIS 诊断（无令人关注的曲线模式、进展率或神经体征/症状提示 AIS 的替代诊断），以及（3）进行了颈椎、胸椎和腰椎的标准术前 MRI。记录所有患者术前 MRI 上 NAA 的患病率。
有 182 名符合条件的患者。14 名患者 MRI 上有 NAA。NAA 的患病率为 7.7% [95%CI 4.27-12.57%]。这一患病率明显[P < 0.0001]高于德尔菲小组确定的 1.3%的临床相关阈值。在术前 MRI 上发现的 14 例 NAA 患者中，建议对 4 例患者（2.2% [95%CI 0.6-5.5%]）进行神经外科干预。
德尔菲小组成员报告称，对于接受 PSF 治疗疑似 AIS 的患者，他们对 NAA 的容忍度较低。如果 NAA 的患病率大于 1.3%，则建议常规筛查。我们队列中的 NAA 患病率以及相关研究的患病率明显高于这一阈值。
诊断 III 级。
