Skip to main content
SpringerLink
Log in

Intraspinal anomalies in scoliosis: An MRI analysis of 177 consecutive scoliosis patients

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: The association of intraspinal neural anomalies with scoliosis is known for more than six decades. However, there are no studies documenting the incidence of association of intraspinal anomalies in scoliotic patients in the Indian population. The guide lines to obtain an magnetic resonance imaging (MRI) scan to rule out neuro-axial abnormalities in presumed adolescent idiopathic scoliosis are also not clear. We conducted a prospective study (a) to document and analyze the incidence and types of intraspinal anomalies in different types of scoliosis in Indian patients. (b) to identify clinico-radiological ‘indicators’ that best predict the findings of neuro-axial abnormalities in patients with presumed adolescent idiopathic scoliosis, which will alert the physician to the possible presence of intraspinal anomalies and optimize the use of MRI in this sub group of patients.

Materials and Methods: The data from 177 consecutive scoliotic patients aged less than 21 years were analyzed. Patients were categorized into three groups; Group A - congenital scoliosis (n=60), group B -presumed idiopathic scoliosis (n=94) and group C - scoliosis secondary to neurofbromatosis, neuromuscular and connective tissue disorders (n=23). The presence and type of anomaly in the MRI was correlated to patient symptoms, clinical signs and curve characteristics.

Results: The incidence of intraspinal anomalies in congenital scoliosis was 35% (21/60), with tethered cord due to flum terminale being the commonest anomaly (10/21). Patients with multiple vertebral anomalies had the highest incidence (48%) of neural anomalies and isolated hemi vertebrae had none. In presumed ‘idiopathic’ scoliosis patients the incidence was higher (16%) than previously reported. Arnold Chiari-I malformation (AC-I) with syringomyelia was the most common neural anomaly (9/15) and the incidence was higher in the presence of neurological findings (100%), apical kyphosis (66.6%) and early onset scoliosis. Isolated lumbar curves had no anomalies. In group-C, incidence was 22% and most of the anomalies were in curves with connective tissue disorders.

Conclusion: The high incidence of intraspinal anomalies in presumed idiopathic scoliosis in our study group emphasizes the need for detailed examination for subtle neurological signs that accompany neuro-axial anomalies. Preoperative MRI screening is recommended in patients with presumed ‘idiopathic’ scoliosis who present at young age, with neurological findings and in curves with apical thoracic kyphosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McMaster MJ. Occult intraspinal anomalies and congenital scoliosis. J Bone Joint Surg Am 1984;66:588–601.

    Article  CAS  Google Scholar 

  2. Noordeen MH, Taylor BA, Edgar MA. Syringomyelia: A potential risk factor in scoliosis surgery. Spine 1994;19:1406–9.

    Article  CAS  Google Scholar 

  3. Ozerdemoglu RA, Denis F, Transfeldt EE. Scoliosis associated with syringomyelia: Clinical and radiologic correlation. Spine 2003;28:1410–7.

    PubMed  Google Scholar 

  4. MacEwen GD, Bunnell WP, Sriram K. Acute neurological complications in the treatment of scoliosis: A report of the Scoliosis Research Society. J Bone Joint Surg Am 1975;57:404–8.

    Article  CAS  Google Scholar 

  5. Peer S, Krismer M, Judmaier W, Kerber W. The value of MRI in the preoperative assessment of scoliosis. Orthopade 1994;23:318–22.

    CAS  PubMed  Google Scholar 

  6. Basu PS, Elsebaie H, Noordeen MH. Congenital spinal deformity: A comprehensive assessment at presentation. Spine (Phila Pa 1976) 2002;27:2255–9.

    Article  Google Scholar 

  7. Bradford DS, Heithoff KB, Cohen M. Intraspinal abnormalities and congenital spine deformities: A radiographic and MRI study. J Pediatr Orthop 1991;11:36–41.

    Article  CAS  Google Scholar 

  8. Suh SW, Sarwark JF, Vora A, Huang BK. Evaluating congenital spine deformities for intraspinal anomalies with magnetic resonance imaging. J Pediatr Orthop 2001;21:525–31.

    CAS  PubMed  Google Scholar 

  9. Phillips WA, Hensinger RN, Kling TF, Jr. Management of scoliosis due to syringomyelia in childhood and adolescence. J Pediatr Orthop 1990;10:351–4.

    Article  CAS  Google Scholar 

  10. Inoue M, Minami S, Nakata Y, Otsuka Y, Takaso M, Kitahara H, et al.. Preoperative MRI analysis of patients with idiopathic scoliosis: A prospective study. Spine (Phila Pa 1976) 2005;30:108–14.

    Article  Google Scholar 

  11. Do T, Fras C, Burke S, Widmann RF, Rawlins B, Boachie-Adjei O. Clinical value of routine preoperative magnetic resonance imaging in adolescent idiopathic scoliosis: A prospective study of three hundred and twenty-seven patients. J Bone Joint Surg Am 2001;83:577–9.

    Article  CAS  Google Scholar 

  12. Shen WJ, McDowell GS, Burke SW, Levine DB, Chutorian AM. Routine preoperative MRI and SEP studies in adolescent idiopathic scoliosis. J Pediatr Orthop 1996;16:350–3.

    Article  CAS  Google Scholar 

  13. Winter RB, Lonstein JE, Heithoff KB, Kirkham JA. Magnetic resonance imaging evaluation of the adolescent patient with idiopathic scoliosis before spinal instrumentation and fusion: A prospective, double-blinded study of 140 patients. Spine (Phila Pa 1976) 1997;22:855–8.

    Article  CAS  Google Scholar 

  14. Dobbs MB, Lenke LG, Szymanski DA, Morcuende JA, Weinstein SL, Bridwell KH, et al.. Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis. J Bone Joint Surg Am 2002;84:2230–4.

    Article  Google Scholar 

  15. Evans SC, Edgar MA, Hall-Craggs MA, Powell MP, Taylor BA, Noordeen HH. MRI of ’idiopathic’ juvenile scoliosis: A prospective study. J Bone Joint Surg Br 1996;78:314–7.

    Article  CAS  Google Scholar 

  16. Gupta P, Lenke LG, Bridwell KH. Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity: Is a magnetic resonance image screening necessary? Spine (Phila Pa 1976) 1998;23:206–10.

    Article  CAS  Google Scholar 

  17. Lewonowski K, King JD, Nelson MD. Routine use of magnetic resonance imaging in idiopathic scoliosis patients less than eleven years of age. Spine (Phila Pa 1976) 1992;17:S109–16.

    Article  CAS  Google Scholar 

  18. Schwend RM, Hennrikus W, Hall JE, Emans JB. Childhood scoliosis: Clinical indications for magnetic resonance imaging. J Bone Joint Surg Am 1995;77:46–53.

    Article  CAS  Google Scholar 

  19. Farley FA, Song KM, Birch JG, Browne R. Syringomyelia and scoliosis in children. J Pediatr Orthop 1995;15:187–92.

    Article  CAS  Google Scholar 

  20. Ferguson RL, DeVine J, Stasikelis P, Caskey P, Allen BL Jr. Outcomes in surgical treatment of “idiopathic-like” scoliosis associated with syringomyelia. J Spinal Disord Tech 2002;15:301–6.

    Article  Google Scholar 

  21. Isu T, Chono Y, Iwasaki Y, Koyanagi I, Akino M, Abe H, et al.. Scoliosis associated with syringomyelia presenting in children. Childs Nerv Syst 1992;8:97–100.

    Article  CAS  Google Scholar 

  22. Goldberg CJ, Dowling FE, Fogarty EE. Left thoracic scoliosis configurations: Why so different? Spine (Phila Pa 1976) 1994;19:1385–9.

    Article  CAS  Google Scholar 

  23. Ozerdemoglu RA, Transfeldt EE, Denis F. Value of treating primary causes of syrinx in scoliosis associated with syringomyelia. Spine (Phila Pa 1976) 2003;28:806–14.

    Google Scholar 

  24. Loder RT, Stasikelis P, Farley FA. Sagittal profiles of the spine in scoliosis associated with an Arnold-Chiari malformation with or without syringomyelia. J Pediatr Orthop 2002;22:483–91.

    PubMed  Google Scholar 

  25. Maiocco B, Deeney VF, Coulon R, Parks PF Jr. Adolescent idiopathic scoliosis and the presence of spinal cord abnormalities: Preoperative magnetic resonance imaging analysis. Spine (Phila Pa 1976) 1997;22:2537–41.

    Article  CAS  Google Scholar 

  26. Ouellet JA, LaPlaza J, Erickson MA, Birch JG, Burke S, Browne R. Sagittal plane deformity in the thoracic spine: A clue to the presence of syringomyelia as a cause of scoliosis. Spine (Phila Pa 1976) 2003;28:2147–51.

    Article  Google Scholar 

  27. Davids JR, Chamberlin E, Blackhurst DW. Indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis. J Bone Joint Surg Am 2004;86:2187–95.

    Article  Google Scholar 

  28. Charry O, Koop S, Winter R, Lonstein J, Denis F, Bailey W. Syringomyelia and scoliosis: A review of twenty-five pediatric patients. J Pediatr Orthop 1994;14:309–17.

    Article  CAS  Google Scholar 

  29. Park JK, Gleason PL, Madsen JR, Goumnerova LC, Scott RM. Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 1997;26:190–6.

    Article  CAS  Google Scholar 

  30. Tokunaga M, Minami S, Isobe K, Moriya H, Kitahara H, Nakata Y. Natural history of scoliosis in children with syringomyelia. J Bone Joint Surg Br 2001;83:371–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 011, Tamil Nadu, India

    S. Rajasekaran, Vijay Kamath, R. Kiran & Ajoy Prasad Shetty

Authors
  1. S. Rajasekaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vijay Kamath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ajoy Prasad Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Rajasekaran.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rajasekaran, S., Kamath, V., Kiran, R. et al. Intraspinal anomalies in scoliosis: An MRI analysis of 177 consecutive scoliosis patients. IJOO 44, 57–63 (2010). https://doi.org/10.4103/0019-5413.58607

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.58607

Key words

Search

Navigation