Role of spinal MRI for pre-operative work up in patients with adolescent idiopathic scoliosis: a retrospective case study and narrative review.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-10-29 DOI:10.1007/s43390-024-00991-z
Sassan Keshavarzi, Griffin Harris, Subaraman Ramchandran, Noah Gabor, Jeffrey Spardy, Thomas Errico, John Ragheb, Stephen George
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Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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脊柱核磁共振成像在青少年特发性脊柱侧凸患者术前检查中的作用:回顾性病例研究和叙述性综述。
简介:在对青少年特发性脊柱侧弯症(AIS)患者进行手术矫正前,全脊柱核磁共振成像的采集仍存在差异。在本研究中,我们对所有确诊为AIS的患者统一进行脊柱核磁共振成像的临床影响进行了回顾性研究:我们对2017年至2022年期间接受手术的334例推测为AIS的患者进行了鉴定;纳入了其中283例无症状并在数据库中进行了术前核磁共振成像的患者。我们调查了出现神经轴异常的影像学、人口统计学和临床风险因素。我们对放射科医生的报告进行了审查,以确定圆锥髓质的水平和脊柱内是否存在发育不良。研究了神经轴异常的已知风险因素的作用,以及核磁共振成像发现异常对无症状AIS患者的临床决策、术中神经监测(IONM)警报和术后神经系统损伤的作用:283 名患者的平均年龄为 14.1 岁,67 名男性(22.6%),26 名患者(9.2%)左侧胸廓弯曲。核磁共振检查发现,9 名患者有中央脊髓扩张,4 名患者有小脑扁桃体低位,4 名患者有Chiari畸形,5 名患者有低位锥体,1 名患者有脊髓系带,5 名患者有蛛网膜囊肿。在283名患者中,有6人(2.1%)接受了神经外科干预,其中3人(50%)接受了IONM警报。283名患者中有18名(6.4%)出现了IONM警报,18名患者中有5名(28%)出现了神经轴异常。在出现IONM警报的患者中,没有人在术后出现永久性神经功能缺损:结论:在推测患有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%的患者有IONM警报。我们没有发现识别神经轴异常的已知风险因素在无症状AIS患者中的应用具有统计学意义。神经轴异常会增加出现 IONM 警报的几率,但是我们无法证明对这些神经轴异常患者进行神经外科干预是否可以预防 IONM 警报或对临床并发症有统计学意义的保护作用。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
期刊最新文献
18th International Congress on Early Onset Scoliosis and the Growing Spine : November 13-15, 2024 Scottsdale, Arizona, USA. A team approach to improve outcomes in pediatric scoliosis surgery: a review of the current literature. Research trends of biomechanics in scoliosis from 1999 to 2023: a bibliometric analysis. Is the information provided by large language models valid in educating patients about adolescent idiopathic scoliosis? An evaluation of content, clarity, and empathy : The perspective of the European Spine Study Group. What imaging does my AIS patient need? A multi-group survey of provider preferences.
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