Introduction: Intraspinal anomalies (IA) are reported to occur in 7% to 19% of patients undergoing surgery for adolescent idiopathic scoliosis (AIS). However, these studies have not focused on IA that require neurosurgical intervention and have not assessed whether deformity characteristics predict their underlying presence. We hypothesized that specific radiographic deformity parameters would be associated with underlying IA in a population of presumed AIS patients undergoing posterior spinal fusion (PSF). Methods: A retrospective cohort study was performed over a 10-year period, identifying all patients with presumed AIS undergoing PSF who had a preoperative total spine MRI at a single, tertiary care pediatric hospital. The presence of an intraspinal anomaly was confirmed by MRI, and subsequent neurosurgical evaluation and intervention were recorded. Coronal and sagittal plane radiographic criteria were recorded, with a focus on previously identified predictive criteria. Radiographic criteria were compared against the whole population, as well as just those with thoracic deformities, seeking to identify factors associated with the presence of IA, as well as those associated with the need for neurosurgical intervention. Results: A total of 427 patients met the inclusion criteria (mean 14.6±2.3 y, 80.7% female). Of these, 33 patients (7.7%) were diagnosed with an IA: 23 syringomyelia, 14 Chiari I malformation, 4 tethered spinal cord, and 8 cerebellar tonsillar ectopia, with only 8 patients (1.9%) undergoing neurosurgical treatment. Thoracic deformities were predominant in 350 patients (81.7%), which was statistically similar for IA and AIS (84.9% vs. 83.3%). For the whole cohort, a left thoracic curve apex was significantly more likely in a patient with an underlying IA (IA: 21% vs. AIS: 6.2%; P <0.001) and was predictive on logistic regression analysis (odds ratio: 0.25, 95% CI: 0.1-0.67; P =0.003). Neurosurgical intervention was also associated with a left thoracic curve apex within the subset of thoracic-only deformities (IA: 38% vs. AIS: 6.5%, P =0.005) with a 37.5% sensitivity and 92.7% specificity. However, all patients requiring neurosurgical intervention also showed neurological symptoms, such as occipital headaches, sleep apnea, or extremity neurological symptoms. Conclusions: The presence of an intraspinal anomaly occurred in 33 patients (7.7%) of this presumed AIS cohort, but only 8 patients (24%) required neurosurgical intervention (1.9% of the total cohort). Only a left thoracic apex was associated with the need for neurosurgical intervention. However, all patients requiring neurosurgical intervention presented with concomitant neurological symptoms. Selective MRI screening protocols incorporating patient sex, radiographic criteria, and neurological indicators may prove sufficient in contrast to universal MRI screening in children with presumed AIS undergoing PSF while minimizing health care expenditures.
Mathes et al. (Fri,) studied this question.