Is the routine use of magnetic resonance imaging indicated in patients with scoliosis?

Abstract

Background: To assess the reliability of the indicators for performing magnetic resonance imaging in patients with scoliosis and assess the incidence of neural axis anomalies in a population with scoliosis referred to a specialist centre.Methods: A retrospective review of magnetic resonance imaging (MRI) reports of all patients under the age of 18 who underwent a pre-operative MRI for investigation of their scoliosis between 2009 and 2014 at a single institution was performed.Results: There were 851 patients who underwent an MRI scan of their whole spine with a mean age of 14.08 years. There were 211 males and 640 females. One hundred and fourteen neural axis abnormalities (NAA) were identified. The presence of a left sided thoracic curve, a double thoracic curve, being male nor being diagnosed before the age of 10 were found to be statistically significant for the presence of a NAA. Furthermore, 2.34% of patients were also found to have an incidental finding (IF) of an extraspinal abnormality.Conclusions: From our series, the reported indications for performing an MRI scan in the presence of scoliosis are not reliable for the presence of an underlying NAA. We have demonstrated that there is a number of intra and extra dural anomalies found on MRI without clinical symptoms and signs. This acts as normative information for this group.

Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints

“…Finally, radiologists frequently report abnormalities on MRI that are routinely ignored by the treating surgeon or deemed clinically inconsequential (58% of reported abnormalities in our cohort). This clinical reality has been noted by others, 6,9,15,21 including the lack of correlation between reported facet abnormality/effusion, in the absence of supporting clinical manipulative challenge of the abnormal region. 22,23 Therefore, treating surgeons should be aware, and patient/families educated to the likelihood of clinically inconsequential abnormalities in radiologists’ formal reports of these studies.…”

The rate of intraspinal problems and clinical evaluation of scoliosis: A cross-sectional, descriptive study

“…[ 3 ] The right convex thoracic with or without left lumbar curve is usually accepted the typical curve pattern in adolescent idiopathic scoliosis, and left thoracic, particularly in males, is accepted as the atypical curve pattern. [ 19 , 20 ] Further investigation is needed for an atypical curve (e.g., a curve less than six segments [a short curve], kyphosis near to curve’s apex, decreased rotation of apex, and rapid progression) and sclerosis or osseous destruction (e.g., an infection or underlying tumor). [ 20 , 21 ] Unfortunately, intraspinal problems (e.g., syrinx or tethered cord) occasionally show the same curve pattern as typical scoliosis.…”

The relationship between measures of spinal deformity and measures of thoracic trunk rotation

“…As is standard care for this group in this institution, all patients had both radiographs and surface topography imaging at each planned attendance to the hospital. Also, it is the protocol of the hospital that all patients with AIS undergo an MRI scan (unless contra-indicated) of the whole spine and neural axis to confirm the diagnosis of AIS and rule out any intra-dural anomalies that could be associated with scoliosis (19,20). As part of this imaging, axial slices of the apex of the deformity are a routine imaging series, specifically performed to look for the presence of a syrinx in the spinal cord at the apex.…”