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Magnetic Resonance Imaging Evaluation of Patients With Idiopathic Scoliosis: A Prospective Study of Four Hundred Seventy-Two Outpatients

Nakahara, Daishi, MD*; Yonezawa, Ikuho, MD*; Kobanawa, Koji, MD; Sakoda, Junta, MD*; Nojiri, Hidetoshi, MD*; Kamano, Shunya, MD*; Okuda, Takatoshi, MD*; Kurosawa, Hisashi, MD*

doi: 10.1097/BRS.0b013e3181e029ed
Diagnostics
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Study Design. A prospective study of magnetic resonance imaging findings in outpatients with idiopathic scoliosis.

Objective. The purpose of this study was to determine the prevalence of neural axis abnormalities in outpatients with scoliosis and to analyze the characteristics of patients who had such abnormalities.

Summary of Background Data. In previous studies, neural axis abnormalities were found in 2.9% to 37% of patients with idiopathic scoliosis. The current guidelines for MRI screening in scoliosis are valuable, and the proposed indications for performing MRI in the literature include early onset, atypical curvature, double thoracic curve (King type-5), rapid progression, male gender, and abnormal neurologic findings.

Methods. A total of 472 outpatients with a primary diagnosis of idiopathic scoliosis were examined for neural axis abnormalities by magnetic resonance imaging. Logistic regression was used to determine significant predictors of neural axis abnormalities on MRI.

Results. The incidence of neural axis abnormalities on MRI was 3.8% (18 of 472 patients). Among the 18 patients, 6 had a Chiari I malformation alone, 10 had a Chiari I malformation combined with syringomyelia, and 2 had a syringomyelia without Chiari I malformation. Male gender, patients younger than 11 years old, and abnormal superficial abdominal reflexes were significantly associated with the detection of neural axis abnormalities on MRI.

Conclusion. We recommend routine use of MRI in male patients, younger than 11 years old, and abnormal superficial abdominal reflexes. Even if a patient has no specific indications for MRI, we recommend its routine use in preoperative planning.

We performed a prospective study of 472 outpatients with a primary diagnosis of idiopathic scoliosis. The incidence of neural axis abnormalities on MRI was 3.8% (18 of 472 patients). Male gender, age at first visit, and abnormal superfi cial abdominal refl exes were signifi cantly associated with neural axis abnormalities on MRI.

*Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan

Department of Orthopaedic Surgery, Kyoundo Hospital, Tokyo, Japan.

Address correspondence and reprint requests to Ikuho Yonezawa, MD, Department of Orthopaedic Surgery, Juntendo University, 2–1-1 Hongo, Bunkyo-ku, Tokyo 113–8421, Japan; E-mail: yoza@juntendo.ac.jp

Acknowledgment date: August 18, 2008. First revision date: February 3, 2010. Acceptance date: March 8, 2010.

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 anyform have been or will be received from a commercial party relateddirectly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.