Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: Experience with 25 patients

Emery, Évelyne; Redondo, A; Rey, Alain

doi:10.1007/bf01301429

Cited by 60 publications

(25 citation statements)

References 13 publications

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“…The finding that the majority of abnormalities consisted of an Arnold-chiari malformation with concurrent syrinx is consistent with the majority of previous studies in the literature [2][3][4][5]7]. It is still not clear whether these intraspinal anomalies are a cause of abnormal curvature of the spine or a result of medullary traction secondary to scoliosis [19,20]. Although age at diagnosis was significantly later (3 years 7 months vs. 5 years 8 months) in those found to have a neuro-axial anomaly, there was no significant difference in Cobb angle between patients with normal (46.6°) and abnormal (45.8°) neural axes.…”

Section: Discussionsupporting

confidence: 83%

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

2012

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Purpose Rates of neural axis abnormalities in infantile and juvenile idiopathic scoliosis may be as high as 50 %. We aimed to determine the rates of neural axis abnormalities in early onset idiopathic scoliosis patients in a British population. Methods This retrospective study at two British spinal deformity clinics identified 72 patients satisfying the inclusion criteria of: (1) age at diagnosis of 7 years and younger, (2) idiopathic scoliosis and (3) magnetic resonance imaging of the neuraxis. Results The mean age at diagnosis was 3.6 years and the mean Cobb angle was 47°with a near equal distribution of left (32) and right (36) sided curves. Eight (11.1 %) neural axis abnormalities consisting of two syrinxes, one Arnoldchiari Type I malformation and five combined (Arnold-chiari malformation Type I and syrinx) anomalies were identified. Conclusions This multi-centre study on the largest number of British subjects to date helps to establish the rates of neural axis abnormalities.

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Section: Discussionsupporting

confidence: 83%

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

2012

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“…Although the present study included only patients with severe AIS requiring surgery (Cobb angle >43°), we did not find a higher incidence of structural spinal intradural pathologies compared with other reports in which cases with less severe scoliosis were also included [3,5,7,10,11,16,19]. We found structural intradural pathology in 3 of 100 AIS patients (3%) who presented without any obvious neurological deficits.…”

Section: Discussioncontrasting

confidence: 69%

Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients

Hausmann

Böni

Pfirrmann

et al. 2003

European Spine Journal

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This is a prospective study of spinal magnetic resonance imaging (MRI), electrophysiological recordings, and neurological examinations of 100 patients admitted for surgery for adolescent idiopathic scoliosis (AIS), which was conducted to assess the prevalence of structural and functional abnormalities within the spinal cord in patients with clinically normal neurologic condition. In all patients the clinical diagnosis and intact neurological condition was ascertained by a spinal orthopedic surgeon. Full-length spinal axis MRI studies (T1/T2 sequences) and somato-sensory evoked potentials of the tibial nerves (tSSEPs) were preoperatively assessed by independent evaluators blinded to the patients' medical histories. Structural spinal cord abnormalities were found in three of 100 AIS patients on MR imaging. In one patient a Chiari malformation type 1 with an accompanying syringomyelia was diagnosed, which required a suboccipital decompression. In the other two patients small thoracic syringomyelias were diagnosed. Abnormalities of spinal cord function were detected in 68% of the 100 patients: tSSEP latencies corrected for body height were increased in 56% of the patients; pathological differences between tSSEPs on the left and right sides were present in 17% (12% in combination with a prolongation of the latency). The findings of this study indicate that MRI and electrophysiological examinations are essential to assess spinal cord abnormalities that are clinically not detectable in AIS patients. Even in patients with intact neurologic condition and clinically typical right-curved thoracic scoliosis, the possibility of intraspinal pathologies should be ruled out by MRI. It is especially important to detect structural pathologies like syringomyelia and Chiari malformation before proceeding with scoliosis surgery, as these conditions are associated with a higher neurological risk during scoliosis surgery. The electrophysiological recordings made in the present study, with the high number of pathological tSSEPs, are indicative of functional abnormalities with a subclinical involvement of the recorded neuronal pathways. The relevance of the latter findings is not yet clear, but pre-operative tSSEP examinations offer the possibility of assessing alterations in spinal cord function that are undetectable by clinical examination.

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“…The diagnosis of IS is one of exclusion, and should be made after excluding other underlying etiologic factors including neuromuscular or skeletal congenital anomalies, or inflammatory or demyelinizing processes [1,2]. In some patients with neural axis abnormalities, scoliosis could be the only clinical sign, and would always be falsely classified as an ''idiopathic'' form [3,4]. Previous studies have demonstrated that the existence of neural axis abnormalities would add the risks of neurologic injury during correction surgery for scoliosis [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…However, the routine use of MRI is controversial, and the indications for MRI in presumed ''idiopathic'' scoliosis vary from study to study [7][8][9][10]. Many predictive factors, including curve pattern, age, gender, radiographic parameters and the presence of abnormal findings on the history or physical examination have been proposed when deciding whether or not to image the neural axis in patients with presumed ''idiopathic'' scoliosis [4][5][6][7][8]. Among these factors, curve pattern may be the most widely recognized and simplest sign to predict the presence of neural axis abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

Qiao

Zhu

et al. 2012

Eur Spine J

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Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: Experience with 25 patients

Cited by 60 publications

References 13 publications

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

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