TY - JOUR
T1 - Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis
T2 - a systematic review
AU - Heemskerk, Johan L.
AU - Kruyt, Moyo C.
AU - Colo, Dino
AU - Castelein, René M.
AU - Kempen, Diederik H.R.
N1 - Funding Information:
Author disclosures: JLH: Nothing to disclose. MCK: Nothing to disclose. DC: Nothing to disclose. RMC: Speaking and/or Teaching Arrangements: K2M (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): K2M (E, Paid directly to institution/employer); Grants: AO Spine (D, Paid directly to institution/employer), outside the submitted work. DHRK: Grants: AO start-up grant (F, Paid directly to institution/employer), Innovation fund (E, Paid directly to institution/employer); Fellowship Support: DePuy Synthes (F, Paid directly to institution/employer), outside the submitted work.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/7
Y1 - 2018/7
N2 - Background: There is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies that could complicate deformity surgery. However, routine MRI increases health-care costs significantly and may reveal mild variations from normal findings without clinical relevance, which can still lead to anxiety and influence decision-making. Purpose: Given the necessity to make evidence-based decisions both in the light of quality of care and cost control, the aim of this review is to report the prevalence of neural axis anomalies in IS and to identify risk factors associated with these anomalies. Study design: A systematic review was carried out. Methods: An electronic search of PubMed, Embase, Cochrane, and Cinahl until May 2017 was performed. Studies were assessed by two reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (diagnosis other than IS). Results: Fifty-one studies were included comprising 8,622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalence was 10.5%, 9.0%, and 14.2% when screening was performed of all IS patients, preoperative patients, or patients with presumed risk factors. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%), or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%), and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early-onset scoliosis, male gender, atypical curves, thoracic kyphosis, and abnormal neurologic findings such as reflexes and sensation. Conclusions: This systematic review shows that a significant number of patients have intraspinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in preselected patient groups with specific risk factors.
AB - Background: There is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies that could complicate deformity surgery. However, routine MRI increases health-care costs significantly and may reveal mild variations from normal findings without clinical relevance, which can still lead to anxiety and influence decision-making. Purpose: Given the necessity to make evidence-based decisions both in the light of quality of care and cost control, the aim of this review is to report the prevalence of neural axis anomalies in IS and to identify risk factors associated with these anomalies. Study design: A systematic review was carried out. Methods: An electronic search of PubMed, Embase, Cochrane, and Cinahl until May 2017 was performed. Studies were assessed by two reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (diagnosis other than IS). Results: Fifty-one studies were included comprising 8,622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalence was 10.5%, 9.0%, and 14.2% when screening was performed of all IS patients, preoperative patients, or patients with presumed risk factors. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%), or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%), and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early-onset scoliosis, male gender, atypical curves, thoracic kyphosis, and abnormal neurologic findings such as reflexes and sensation. Conclusions: This systematic review shows that a significant number of patients have intraspinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in preselected patient groups with specific risk factors.
KW - Chiari malformation
KW - Idiopathic scoliosis
KW - Magnetic resonance imaging
KW - Neural axis anomalies
KW - Prevalence
KW - Risk factors
KW - Syrinx
UR - http://www.scopus.com/inward/record.url?scp=85044001867&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2018.02.013
DO - 10.1016/j.spinee.2018.02.013
M3 - Review article
C2 - 29454133
AN - SCOPUS:85044001867
SN - 1529-9430
VL - 18
SP - 1261
EP - 1271
JO - Spine Journal
JF - Spine Journal
IS - 7
ER -