Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis
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Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis Rafael Garcia de Oliveira1 · Alex Oliveira de Araújo1 · Cícero Ricardo Gomes1 Received: 29 March 2020 / Accepted: 3 September 2020 © Scoliosis Research Society 2020
Abstract Objective To assess the effectiveness of preoperative magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis (AIS) patients with unremarkable history and physical examination. Methods The imaging data of consecutive patients with presumed AIS treated with a posterior spinal fusion between 2010 and 2016 were reviewed. The presence of traditional risk factors, atypical curve patterns, and its association with relevant abnormalities on MRI were investigated. The number needed to diagnose (NND) and the number needed to misdiagnose (NNM) were calculated to measure MRI effectiveness. Results A total of 198 consecutive patients were identified and divided according to the presence of MRI findings. Both groups predominantly consisted of females, with a mean age of 15 years and right thoracic curvature. Neural axis abnormali‑ ties were detected in 25 patients, and the groups had a similar proportion of atypical findings, as curve magnitude, thoracic kyphosis, curve direction, and sex. The NND was 7.9 patients and NNM was 66 patients, meaning that the management was changed before the spine fusion in 12% of patients with neural axis abnormalities. None of the traditional risk factors could predict a higher incidence of neural axis abnormalities in asymptomatic AIS patients. Conclusion Traditional risk factors may not be predictive of patients with a higher risk of changes in MRI. Both NND and NNM are representations easily understood by clinicians. Using these indexes to define if a patient should be submitted for additional imaging tests may facilitate the decision of using MRI as a preoperative screening tool in AIS patients. Level of evidence Level II Keywords Adolescent idiopathic scoliosis · Magnetic resonance imaging · Neural axis abnormality · Posterior fusion · Clinical investigation
Introduction Adolescent idiopathic scoliosis (AIS) is diagnosed on the basis of exclusion of other pathologies through clinical examination and complementary investigations. The inves‑ tigation of choice to assess patients with AIS is a full spine radiograph in the standing position, which facilitates the identification of the curve pattern, severity, and flexibility, as well as the presence of congenital malformations. How‑ ever, it cannot identify neural axis abnormalities in patients with AIS [1–3]. * Rafael Garcia de Oliveira [email protected] 1
Department of Orthopedics, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF 70335‑901, Brazil
In the past decades, the MRI technique has improved and gradually become more accessible, resulting in greater rec‑ ognition of neural axis and anatomical abnormalities with proven etiological importance where previously a diagno‑ sis of idiopathic scoliosis was made [1–4]. The incide
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