Background
Methods
Subjects
Case | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
---|---|---|---|---|---|---|---|---|---|
Age (years) | 28 | 8 | 12 | 9 | 14 | 16 | 6 | 11 | 12 |
Gender | M | M | F | F | F | M | F | M | F |
Abnormality | Chiari | Syrinx | Chiari | Syrinx | Chiari | Chiari | Chiari | Chiari | Chiari |
Cobb angle (°) | 90 | 60 | 105 | 85 | 71 | 56 | (38) | (23) | (30) |
Flexibility (%) | 52 | 78 | 55 | 50 | 56 | 58 | None | None | None |
SAR | Bil hypo | R abs | L abs | Bil hypo | L abs | L hypo | L abs | L hypo | Normal |
Convex side | rt T | rt T | rt T | rt T | lt T | rt T+ lt L | lt T-L | lt L | rt T |
Corrective surgery | ASF | ASF | ASF + PSF | ASF + PSF | PSF | PSF | None | None | None |
Neurosurgery | None | SS | FMD | SS | FMD | FMD+ SS | FMD | FMD | None |
Neurological assessment
Radiograph assessment
Magnetic resonance imaging
Statistical analysis
Results
Abnormal SAR among all patients with scoliosis
Abnormal SAR | Number of cases | Diagnosis |
---|---|---|
A: Bilateral absence | 6 | 6 myopathic |
B: Unilateral absence | 6 | 4 syringomyelia |
1 thoracogenic (after abdominal surgery) | ||
1 myelomeningocele (after abdominal surgery) | ||
C: Bilateral hyporeflexia | 5 | 2 syringomyelia |
1 Duchenne muscular dystrophy | ||
2 idiopathic | ||
D: Unilateral hyporeflexia | 3 | 2 syringomyelia |
1 thoracogenic (after abdominal surgery) |
Non-idiopathic | Idiopathic | Total | ||
---|---|---|---|---|
Abnormal SAR | 18 | 2 | 20 | PPV 90% |
Normal SAR | 29 | 44 | 73 | NPV 60% |
Total | 47 | 46 | 93 | |
Sensitivity 38% | Specificity 96% |
Abnormal SAR in patients with syringomyelia
Syringomyelia | No syringomyelia | Total | ||
---|---|---|---|---|
Abnormal SAR | 8 | 12 | 20 | PPV 40% |
Normal SAR | 1 | 72 | 73 | NPV 99% |
Total | 9 | 84 | 93 | |
Sensitivity 89% | Specificity 86% |
Syringomyelia | No syringomyelia | Total | ||
---|---|---|---|---|
Abnormal SAR | 8 | 2 | 10 | PPV 80% |
Normal SAR | 1 | 44 | 45 | NPV 98% |
Total | 9 | 46 | 55 | |
Sensitivity 89% | Specificity 95% |
Curve flexibility of patients with syringomyelia
Syringomyelia (6 operated cases) | Idiopathic scoliosis (46 operated cases) | P | |
---|---|---|---|
Gender (% male) | 44 | 4.3 | 0.02*† |
Age (years) | 14.5 (8-28) | 14.1 (7-21) | 0.44 |
Risser sign | 2.8 (0-5) | 3.4 (0-5) | 0.27 |
Curve magnitude(°) | 78 (56-105) | 69 (45-128) | 0.17 |
Curve flexibility (%) | 58 (50-78) | 44 (11-96) | 0.02* |
Syringomyelia | No syringomyelia | Total | ||
---|---|---|---|---|
Flexibility ≥ 50% | 6 | 17 | 23 | PPV 26% |
Flexibility < 50% | 0 | 29 | 29 | NPV 100% |
Total | 6 | 46 | 52 | |
Sensitivity 100% | Specificity 63% |
Other indicators for scoliosis with syringomyelia
Relationship between syrinx type and neurological abnormality
Case | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
---|---|---|---|---|---|---|---|---|---|
Syrinx type
|
Slit
|
Swelling
|
Slit
|
Swelling
|
Swelling
|
Swelling
|
Swelling
|
Swelling
|
Spindle
|
Syrinx level | C3-7 | Th6-9 | C5-7 | C5-8 | C5-9 | C2-7 | C1-L1 | C2-Th11 | C5-8 |
Syrinx length (vertebra) | 5 | 4 | 3 | 4 | 5 | 6 | 20 | 17 | 4 |
SAR | Bil hypo | R abs | L abs | Bil hypo | L abs | L hypo | L abs | L hypo | Normal |
Other neurological findings | Bil Babinski reflex | Hyper of L/E | None | Hyper of L/E | Hypo of L/E | Hyper of ATR | Hypo of L/E | Headache SD of left L/E | None |
Discussion
Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | N | |
---|---|---|---|---|---|
Inoue (2004) * | 34 | 97 | 71 | 87 | 250 |
Saifuddin (2005) * | 22 | 90 | 25 | 89 | 73 |
Present study | 89 | 95 | 80 | 98 | 55 |