Cervical Abnormalities in Severe Spinal Deformity: A 10-year MRI Review

Area of Science:

• Spine surgery
• Orthopedics
• Radiology

Background:

• Severe spinal deformities (SSD) can be associated with complex anatomical variations.
• Cervical anomalies (CA) encompass both bony (COA) and neural axis (CIINAA) abnormalities.
• Understanding the prevalence and clinical relevance of CA in SSD is crucial for surgical planning and patient management.

Purpose of the Study:

• To determine the incidence of cervical anomalies (CA) in patients with severe spinal deformities (SSD).
• To investigate the types of CA, including cervical intraspinal neural axis abnormalities (CIINAA) and cervical osseous abnormalities (COA).
• To analyze the clinical relevance and associations of CA with radiographic characteristics in SSD patients.

Main Methods:

• Retrospective study of 108 severe spinal deformity patients undergoing surgery between 2003 and 2015.
• Inclusion criteria: coronal Cobb >90° and/or sagittal Cobb ≥90°, with complete pre-operative imaging and clinical data.
• Exclusion criteria: ankylosing spondylitis, adult-onset scoliosis, and scoliosis secondary to bone destruction.

Main Results:

• Cervical anomalies (CA) were detected in 51.85% of SSD patients.
• The most frequent COA were basilar invagination and Klippel-Feil syndrome; syringomyelia was the most frequent CIINAA.
• SSD with COA in upper vertebral levels showed a higher incidence of CIINAA, especially with multiple COA (P=0.024, P=0.029).

Conclusions:

• Cervical anomalies (CA) are highly prevalent (51.85%) in severe spinal deformities (SSD).
• Increased diversity of cervical osseous abnormalities (COA) is associated with a higher incidence of cervical intraspinal neural axis abnormalities (CIINAA), particularly in upper vertebral levels.
• The majority of SSD patients with CA (83.9%) were asymptomatic, highlighting the importance of thorough screening.