Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis: a systematic review

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Johan L Heemskerk¹, Moyo C Kruyt², Dino Colo²

¹Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.

The Spine Journal : Official Journal of the North American Spine Society

|February 18, 2018

Abstract

Background:

There is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies that could complicate deformity surgery. However, routine MRI increases health-care costs significantly and may reveal mild variations from normal findings without clinical relevance, which can still lead to anxiety and influence decision-making.

Purpose:

Given the necessity to make evidence-based decisions both in the light of quality of care and cost control, the aim of this review is to report the prevalence of neural axis anomalies in IS and to identify risk factors associated with these anomalies.

Study Design:

A systematic review was carried out.

Methods:

An electronic search of PubMed, Embase, Cochrane, and Cinahl until May 2017 was performed. Studies were assessed by two reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (diagnosis other than IS).

Results:

Fifty-one studies were included comprising 8,622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalence was 10.5%, 9.0%, and 14.2% when screening was performed of all IS patients, preoperative patients, or patients with presumed risk factors. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%), or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%), and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early-onset scoliosis, male gender, atypical curves, thoracic kyphosis, and abnormal neurologic findings such as reflexes and sensation.

Conclusions:

This systematic review shows that a significant number of patients have intraspinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in preselected patient groups with specific risk factors.

Insights

Routine preoperative MRI for idiopathic scoliosis (IS) reveals neural axis anomalies in 11.4% of patients. Specific risk factors increase this prevalence, aiding in evidence-based decision-making for spinal deformity surgery.

Area of Science:

Neurosurgery
Orthopedic Surgery
Radiology

Background:

Controversy exists regarding routine preoperative magnetic resonance imaging (MRI) for presumed idiopathic scoliosis (IS).
While MRI can detect anomalies complicating surgery, it increases costs and may identify clinically insignificant findings.
Evidence-based decisions are needed to balance quality of care and cost-effectiveness.

Purpose of the Study:

To determine the prevalence of neural axis anomalies in patients with IS.
To identify risk factors associated with these intraspinal anomalies.

Main Methods:

A systematic review of electronic databases (PubMed, Embase, Cochrane, Cinahl) was conducted.
Studies involving MRI in presumed IS patients were included, with 51 studies comprising 8,622 patients analyzed.
Two reviewers independently assessed study eligibility.

Main Results:

Overall prevalence of intraspinal anomalies was 11.4% (981/8622 patients).
Prevalence increased in specific groups: 10.5% in all IS patients, 9.0% in preoperative patients, and 14.2% in those with risk factors.
Common anomalies included syrinx (3.7%) and Arnold-Chiari malformation (3.0%); risk factors included early-onset scoliosis, male gender, atypical curves, and abnormal neurological findings.

Conclusions:

A significant proportion of patients with presumed IS have intraspinal anomalies detected by preoperative MRI.
The likelihood of identifying spinal axis abnormalities is higher in preselected patient groups with specific risk factors.
These findings support targeted MRI use in IS management.

Read full analysis

Keywords:

Chiari malformation Idiopathic scoliosis Magnetic resonance imaging Neural axis anomalies Prevalence Risk factors Syrinx

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