ACR Appropriateness Criteria® Scoliosis-Child

Abstract

Scoliosis is frequently encountered in childhood, with prevalence of 2%. The majority is idiopathic, without vertebral segmentation anomaly, dysraphism, neuromuscular abnormality, skeletal dysplasia, tumor, or infection. As a complement to clinical assessment, radiography is the primary imaging modality used to classify scoliosis and subsequently monitor its progression and response to treatment. MRI is utilized selectively to assess for neural axis abnormalities in those at higher risk, including those with congenital scoliosis, early onset idiopathic scoliosis, and adolescent idiopathic scoliosis with certain risk factors. CT, although not routinely employed in the initial evaluation of scoliosis, may have a select role in characterizing the bone anomalies of congenital scoliosis and in perioperative planning.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Is the numerical rating scale an adequate predictor for assessing MRI underlying pathologies among painful adolescent idiopathic scoliosis patients?

“…Recently, the American College of Radiology published their Appropriateness Criteria guidelines to help clinicians define the most appropriate risk factors that could identify an underlying pathology in AIS patients [20]. In their study, patients with the left thoracic curve, short segment curve, hyperkyphosis, rapid curve progression, focal neurologic findings, male sex, pes cavus and functionally disruptive pain were recommended to undergo MRI screening for further evaluation [20]. In 2020, Ramirez et al published a case series study where they demonstrated that one out of three painful AIS patients would have an underlying pathology [3].…”

“…The goal of these studies was to elaborate on a screening protocol that could minimize the use of extensive diagnostic workup in this population. Recently, the American College of Radiology published their Appropriateness Criteria guidelines to help clinicians define the most appropriate risk factors that could identify an underlying pathology in AIS patients [20]. In their study, patients with the left thoracic curve, short segment curve, hyperkyphosis, rapid curve progression, focal neurologic findings, male sex, pes cavus and functionally disruptive pain were recommended to undergo MRI screening for further evaluation [20].…”

The value of magnetic resonance imaging and computed tomography in the study of spinal disorders

“…Radiography is usually the first imaging method to study congenital vertebral anomalies and related deformities, allowing their classification, evaluation of severity, risk of deformity progression, and vertebral count (15). As the number of bone malformations increases, there is a higher incidence of cord anomalies ranging from 20% to 58% (9,15,16), being higher in the presence of combined failures of segmentation and formation.…”

The role of radiography in the study of spinal disorders

“…Radiography is usually the first imaging method to study congenital vertebral abnormalities and related deformities, allowing their classification, evaluation of severity and assessment of risk of progression (16). As the number of bony malformations increases, there is a higher incidence of cord anomalies ranging from 20% to 58% (16)(17)(18) and being greater in the presence of combined failures of segmentation and formation (18). MRI is the appropriate technique for complete evaluation of intraspinal abnormalities.…”