Current practices in MRI screening in early onset scoliosis

Early onset scoliosis (EOS) has traditionally been an indication for MRI because of its association with neural axis abnormalities (NAAs). Because these abnormalities are often clinically silent and concerns regarding sedation in young children are growing, routine MRI for EOS is debated. This study investigates the current practices of EOS MRI screening among surgeons in the Pediatric Spine Study Group (PSSG).

A survey assessing EOS MRI practices was distributed to the PSSG. The survey presented scenarios that varied in age, curve size, and diagnosis and asked which scenarios would indicate an MRI. Respondents also ranked age, curve progression, etiology, and need for sedation by level of importance when considering to order MRI.

Age and curve progression were ranked as the most important factors when deciding to order MRI. For all non-congenital scoliosis, increased age and curve size were associated with increased rates of MRI among respondents. For idiopathic EOS, more than 60% of respondents would order MRI for patients with curve magnitudes of 45° regardless of age. All respondents would order MRI for congenital EOS before surgery and for EOS caused by neurofibromatosis. For EOS secondary to cerebral palsy, 61% of respondents would order an MRI, and 34% believe that EOS and Prader-Willi syndrome require MRI.

Our results indicate that the MRI screening practices for EOS vary greatly between physicians, as expected. Future research on the prevalence of NAAs in EOS and the clinical outcomes of routine MRI is needed to inform which MRI practices should be standard.