Li Austin W, Chang Alexander, Murphy Joshua S, Li Ying, Roye Benjamin, Hardesty Christina K, Glotzbecker Michael P
Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Pediatric Orthopedic Surgery, George H Thompson Chair in Pediatric Orthopaedics, Rainbow Babies and Childrens Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Spine Deform. 2025 May;13(3):961-966. doi: 10.1007/s43390-024-01033-4. Epub 2025 Jan 22.
Early onset scoliosis (EOS) has traditionally been an indication for MRI because of its association with neural axis abnormalities (NAAs). Because these abnormalities are often clinically silent and concerns regarding sedation in young children are growing, routine MRI for EOS is debated. This study investigates the current practices of EOS MRI screening among surgeons in the Pediatric Spine Study Group (PSSG).
A survey assessing EOS MRI practices was distributed to the PSSG. The survey presented scenarios that varied in age, curve size, and diagnosis and asked which scenarios would indicate an MRI. Respondents also ranked age, curve progression, etiology, and need for sedation by level of importance when considering to order MRI.
Age and curve progression were ranked as the most important factors when deciding to order MRI. For all non-congenital scoliosis, increased age and curve size were associated with increased rates of MRI among respondents. For idiopathic EOS, more than 60% of respondents would order MRI for patients with curve magnitudes of 45° regardless of age. All respondents would order MRI for congenital EOS before surgery and for EOS caused by neurofibromatosis. For EOS secondary to cerebral palsy, 61% of respondents would order an MRI, and 34% believe that EOS and Prader-Willi syndrome require MRI.
Our results indicate that the MRI screening practices for EOS vary greatly between physicians, as expected. Future research on the prevalence of NAAs in EOS and the clinical outcomes of routine MRI is needed to inform which MRI practices should be standard.
早发性脊柱侧弯（EOS）传统上一直是进行磁共振成像（MRI）检查的适应证，因为它与神经轴异常（NAA）有关。由于这些异常在临床上通常没有症状，并且对幼儿镇静的担忧日益增加，因此对于EOS是否进行常规MRI检查存在争议。本研究调查了小儿脊柱研究组（PSSG）外科医生目前对EOS进行MRI筛查的做法。
向PSSG发放了一份评估EOS MRI检查做法的调查问卷。该调查问卷呈现了年龄、侧弯大小和诊断各不相同的情景，并询问哪些情景需要进行MRI检查。在考虑开具MRI检查单时，受访者还按重要程度对年龄、侧弯进展、病因和镇静需求进行了排序。
在决定开具MRI检查单时，年龄和侧弯进展被列为最重要的因素。对于所有非先天性脊柱侧弯，年龄增长和侧弯大小增加与受访者中进行MRI检查的比例增加相关。对于特发性EOS，超过60%的受访者会为侧弯角度为45°的患者开具MRI检查单，无论其年龄如何。所有受访者都会在先天性EOS手术前以及对神经纤维瘤病引起的EOS开具MRI检查单。对于脑瘫继发的EOS，61%的受访者会开具MRI检查单，34%的受访者认为EOS和普拉德-威利综合征需要进行MRI检查。
我们的结果表明，正如预期的那样，医生对EOS的MRI筛查做法差异很大。需要对EOS中NAA的患病率以及常规MRI的临床结果进行进一步研究，以确定哪些MRI检查做法应成为标准。
