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Pedicle Rotation in Scoliosis: A Marker for Occult Intrathecal Abnormalities

Hooker, Michael Sean, MD*; Yandow, Suzanne M., MD; Fillman, Ramona R., MHA; Raney, Ellen M., MD

doi: 10.1097/01.brs.0000201326.00208.b4
Diagnostics
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Study Design. The Perdriolle method was used to assess retrospectively radiographic pedicle rotation for association with occult intrathecal abnormalities in patients with scoliosis.

Objective. To determine if pedicle rotation can be predictive of underlying intrathecal abnormalities.

Summary of Background Data. Scoliosis associated with intrathecal abnormalities is thought to produce less rotation than true idiopathic scoliosis. No supporting evidence was found in the literature.

Methods. A consecutive series of patients with a presenting diagnosis of idiopathic scoliosis were reviewed for anteroposterior radiographs and spinal magnetic resonance imaging (MRI). A blinded single examiner evaluated radiographic curve parameters. MRI reports were reviewed for the presence or absence of intrathecal abnormalities.

Results. A total of 78 MRIs included 15 intrathecal abnormalities and 63 normals. The abnormal MRI group had more males and apex left curves. Primary curve in the intrathecal abnormality group had a mean of 9.6° of apical vertebrae rotation compared to 17.7° in idiopathic curves (average 37° and 40° Cobb angles, respectively). Of angulation, 1° correlated with 0.21° and 0.34° of rotation in intrathecal abnormality versus no abnormality groups, respectively.

Conclusions. Curves with occult intrathecal pathology had significantly less rotation than those without. Pedicle rotation assessment is a useful adjuvant for identifying scoliosis with intrathecal abnormalities.

The Perdriolle method was used to assess retrospectively radiographic pedicle rotation, which was compared with magnetic resonance imaging reports for association with occult intrathecal abnormalities in patients presenting with apparent idiopathic scoliosis. A total of 78 magnetic resonance images included 15 intrathecal abnormalities and 63 normals. Curves with occult intrathecal pathology had significantly less apical rotation than those without.

From *Richmond Hill, GA, and †Shriners Hospital for Children-Honolulu, Honolulu, HI.

Acknowledgment date: September 13, 2004. First revision date: July 13, 2005. Acceptance date: July 25, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Ellen Raney, MD, Chief of Staff, Shriners Hospital for Children, 1310 Punahou Street, Honolulu, HI 96826-1099; E-mail: eraney@shrinenet.org

© 2006 Lippincott Williams & Wilkins, Inc.