MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

Area of Science:

• Orthopedics
• Radiology
• Spinal Surgery

Background:

• Adolescent Scheuermann kyphosis (SK) is a spinal deformity requiring surgical intervention.
• The utility of preoperative magnetic resonance imaging (MRI) for identifying neural axis abnormalities in operative SK has not been extensively studied.

Purpose of the Study:

• To evaluate the effectiveness of preoperative MRI screening in operative planning for adolescent Scheuermann kyphosis (SK).
• To identify the prevalence of neural axis abnormalities and other spinal pathologies in patients undergoing surgery for SK.

Main Methods:

• A prospective multicenter study involving 86 patients with preoperative spine MRI.
• Retrospective evaluation of MRIs by orthopedic surgeons and radiologists for spinal cord abnormalities, epidural lipomatosis, vertebral wedging, disc herniations, and spondylolysis.
• Comparison of findings with a control group of SK patients who did not have preoperative MRIs.

Main Results:

• Seventeen spinal cord abnormalities were detected, including low-lying conus (2 patients) and syrinx (15 patients).
• Epidural lipomatosis was present in 49 patients. Anterior vertebral wedging occurred in all patients.
• Preoperative MRI led to a change in operative plans for 4.7% of patients due to neural compression or disc herniation. Postoperative neurologic change rates were similar between MRI and no-MRI groups.

Conclusions:

• Preoperative MRI screening can identify significant spinal pathologies in patients with Scheuermann kyphosis.
• The findings suggest that MRI screening is valuable for operative planning in SK, potentially preventing complications.
• The study recommends considering screening MRI for all operative adolescent SK cases.