Keshavarzi Sassan, Harris Griffin, Ramchandran Subaraman, Gabor Noah, Spardy Jeffrey, Errico Thomas, Ragheb John, George Stephen
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA.
University of Miami Miller School of Medicine, Miami, USA.
Spine Deform. 2025 Mar;13(2):509-518. doi: 10.1007/s43390-024-00991-z. Epub 2024 Oct 29.
There remains variability in the acquisition of whole-spine MRI prior to surgical correction in patients with adolescent idiopathic scoliosis (AIS). In this study, we take a retrospective look at the clinical impact of uniformly obtaining spinal MRI on all patients with a diagnosis of AIS.
Three hundred thirty four patients with presumed AIS who underwent surgery between 2017 and 2022 were identified; 283 of these patients who were asymptomatic and had a preoperative MRI in the database were included. We investigated radiographic, demographic, and clinical risk factors for the presence of neural axis anomalies. Radiologists' reports were reviewed to determine the level of the conus medullaris and the presence of any intra-spinal dysraphisms. The utility of known risk factors for neural axis anomalies and the utility of MRI identifying anomalies on clinical decision-making, intra-operative neuromonitoring (IONM) alerts, and postoperative neurologic insult in asymptomatic AIS patients were investigated.
There were 283 patients with a mean age of 14.1 years, 67 males (22.6%) and 26 (9.2%) left-sided thoracic curves. MRI identified nine patients with central cord dilations, four patients with low cerebellar tonsils, four patients with Chiari Malformations, five patients with low-lying conus, one patient with a tethered cord, and five patients with arachnoid cysts. Six (2.1%) of the 283 patients underwent a neurosurgical intervention and 3 (50%) of the 6 went on to have IONM alerts. Eighteen (6.4%) of the 283 patients had IONM alerts and 5 (28%) of the 18 had neural axis anomalies. None of the patients with IONM alerts had a permanent neurologic deficit post-operatively.
In asymptomatic patients presumed to have AIS, 9.9% had a neuro-axis anomaly, 2.1% needed a neurosurgical intervention, and 6.4% of the patients had an IONM alert. We did not find known risk factors for identifying neural axis anomalies to have statistically significant application in asymptomatic AIS patients. Presence of neuroaxis anomalies increased the chance of having IONM alerts, however, we were unable to demonstrate if neurosurgical interventions in these patients with anomalies were preventative for IONM alerts or have statistically significant protection against clinical complications.
青少年特发性脊柱侧凸（AIS）患者在手术矫正前进行全脊柱MRI检查的情况仍存在差异。在本研究中，我们回顾性研究了对所有诊断为AIS的患者统一进行脊柱MRI检查的临床影响。
确定了2017年至2022年间接受手术的334例疑似AIS患者；其中283例无症状且数据库中有术前MRI检查结果的患者被纳入研究。我们调查了神经轴异常存在的影像学、人口统计学和临床风险因素。审查放射科医生的报告以确定脊髓圆锥水平和任何脊髓内发育异常的存在情况。研究了已知神经轴异常风险因素的效用以及MRI在无症状AIS患者的临床决策、术中神经监测（IONM）警报和术后神经损伤识别异常方面的效用。
共有283例患者，平均年龄14.1岁，其中67例男性（22.6%），26例（9.2%）为左侧胸弯。MRI检查发现9例患者有脊髓中央管扩张，4例患者小脑扁桃体低位，4例患者有Chiari畸形，5例患者脊髓圆锥低位，1例患者脊髓栓系，5例患者有蛛网膜囊肿。283例患者中有6例（2.1%）接受了神经外科干预，其中6例中有3例（50%）出现IONM警报。283例患者中有18例（6.4%）出现IONM警报，18例中有5例（28%）有神经轴异常。所有出现IONM警报的患者术后均无永久性神经功能缺损。
在疑似患有AIS的无症状患者中，9.9%有神经轴异常，2.1%需要神经外科干预，6.4%的患者出现IONM警报。我们未发现已知的神经轴异常识别风险因素在无症状AIS患者中有统计学意义的应用。神经轴异常的存在增加了出现IONM警报的几率，然而，我们无法证明对这些有异常的患者进行神经外科干预是否能预防IONM警报或对临床并发症有统计学意义的保护作用。
