The increasing use of pre-operative MRI has led to growing recognition that asymptomatic adolescent idiopathic scoliosis (AIS) patients may present with neuraxial abnormalities (NAAs). Despite this, the indications for routine MRI in AIS remain controversial, with reported NAA incidences ranging widely from 2.1% to 26%.1 NAAs could significantly impact surgical planning and elevate the risk of intra- or postoperative complications. This study aimed to quantify the incidence of MRI-detected abnormalities in AIS patients and identify characteristics predictive of NAAs and their association with increased intraoperative complication risk. This retrospective, single-center review included all presumed AIS surgical cases with preoperative MRI performed between January 1, 2013 and December 31, 2023. Data collected included demographics, MRI abnormalities and subsequent interventions, patient history, operative details, and intra- and postoperative complications. Sub-analysis assessed curve direction, thoracic kyphosis, major coronal curve magnitude, lumbar lordosis, pelvic incidence, and postoperative residual major coronal curve. Multivariable logistic regression assessed independent variables associated with MRI abnormalities. After chart review, 85 patients were included with a mean age of 14.1 ± 2.0 years and 70.6% (n = 60) of them being females. The total incidence of NAA across all curve types was 18.4% (n = 16), with the majority being a syrinx (n = 7, 38.9%) and Chiari I malformations (n = 4, 22.2%). The mean preoperative major coronal curve angle was 68.9° ± 13.3°, with 77.6% of them being right thoracic curves (n = 66) and 21.2% of the patients being classified as a Lenke 5 or 6 (n = 18). The mean major coronal curve postoperatively was found to be 20.7° ± 8.6°. After logistic regression analysis, pre-operative major coronal curve magnitude was found to be a significant predictor for NAA whereby for every degree increase in major coronal curve, the odds of having an abnormality increased by 6.0% (OR: 1.06; 95% CI: 1.02–1.11, p = .007). Furthermore, having a NAA was found to be significantly positively correlated with degree of major coronal curve correction achieved at the latest follow-up (r = .31, p = .004). Curve direction, location, Lenke classification, nor skeletal maturity were not found to be predictive for increased rates of NAA in the spine. There was no correlation between preoperative radiographic measurements and intra- or postoperative complications. Our findings illustrate the overall incidence of NAAs in AIS and that preoperative major coronal curve magnitude is associated with a higher likelihood of these abnormalities. These findings highlight the importance of refining MRI guidelines to better identify high-risk AIS subgroups. Early detection of NAAs through targeted MRI can guide surgical planning, reduce complications, and improve patient outcomes by ensuring more precise and informed surgical decision-making.
Zgardau et al. (Wed,) studied this question.