Scoliosis as the first sign of a cystic spinal cord lesion

The use of MRI in the study of patients with idiopathic scoliosis: a systematic review of the literature

Objective. To analyze the frequency of hidden neuraxial pathology in idiopathic scoliosis (IS), to substantiate the need for MRI in IS and to identify promising areas for the use of MRI in the examination of patients with IS.Material and Methods. The literature review was carried out using the PubMed and Google Scholar databases. Of the 780 papers on the research topic, 65 were selected after removing duplicates and checking for inclusion/exclusion criteria. As a result, 49 original studies were included in the analysis. Level of evidence – II.Results. According to modern literature, the main direction of using MRI in idiopathic scoliosis is the search for predictors of latent pathology of the spinal cord and craniovertebral junction. The frequency of neuraxial pathology in idiopathic scoliosis is 8 % for adolescent IS and 16 % for early IS. The main predictors of neuraxial pathology are male sex, early age of deformity onset, left-sided thoracic curve and thoracic hyperkyphosis. MRI in IS may be a useful addition to radiological diagnostic methods to identify risk factors and to study degenerative changes in the spine.Conclusion. MRI of the spine should be performed in the early stages of IS to detect latent spinal cord tethering. In type I Chiari anomalies, there is a possibility that early neurosurgery can prevent the development of scoliosis. The main signs of latent neuraxial pathology in IS are early progression of spinal deformity, left-sided thoracic curve, male gender and thoracic kyphosis over 40° according to Cobb.MRI can be used as an effective non-invasive tool in research aimed at identifying risk factors for IS, including helping to track early degeneration of intervertebral discs.

Scoliotic curve patterns in patients with Chiari I malformation and/or syringomyelia

STUDY DESIGN

A retrospective radiographic review was performed on 41 patients with scoliosis associated with a Chiari I malformation and/or syringomyelia.

OBJECTIVES

To characterize curve patterns and curve features in this population and possibly refine the radiographic indications for magnetic resonance imaging in patients with a normal history and physical examination.

SUMMARY OF BACKGROUND DATA

A subset of patients with "idiopathic" scoliosis may have an underlying neurologic abnormality. The radiographic indications for magnetic resonance imaging in asymptomatic patients with a normal clinical examination are not well defined.

METHODS

Data were collected from standing posteroanterior and lateral radiographs. The curve pattern and specific curve features were recorded and compared with historic controls. Thoracic kyphosis and total lumbar lordosis were also measured.

RESULTS

Fifty-one percent of patients were male. Ten curve patterns were identified, and, based on our criteria, approximately 50% of patients had an "atypical" pattern (left thoracic, double thoracic, triple, long right thoracic). A subset of those with "typical" patterns (right thoracic, right thoracic/left lumbar) had atypical features including a superior or inferior shift of the apex and/or the upper or lower end vertebrae. The mean kyphosis (T3-T12) was 41.8 degrees.

CONCLUSIONS

Although the decision to obtain magnetic resonance imaging in a patient with scoliosis should be based on both clinical and radiographic criteria, we suggest that a heightened index of suspicion is warranted with certain curve patterns (left thoracic, double thoracic, triple, and a long right thoracic curve with end vertebra caudal to T12), and with a high or low apex and/or end vertebra, especially in males and patients with a normal to hyperkyphotic thoracic spine.

Is tooth agenesis related to brainstem anomalies in myelomeningocele patients with Chiari II malformations?

Defects in the prenatal development of the brainstem can result in cranial nerve deficiencies. As the development of tooth germ is dependent on n. trigeminus, which originates from the brainstem, the hypothesis underlying this study was that anomalies of the brainstem would lead to an increased prevalence of tooth agenesis. Twenty-three patients (13 F and 10 M, age range 6-37 years) were studied, all with myclomeningocele and brainstem anomalies (Chiari II). They were examined retrospectively from the data in journals and dental radiographs and compared to available data on the prevalence of tooth agenesis in the Swedish population. Our hypothesis was rejected, since there was insignificant difference in the frequency of agenesis in our material (8.7%) compared with that of the Swedish population (7.4%).

Leptomeningeal dissemination of pilocytic astrocytoma via hematoma in a child

A case of recurrent pilocytic astrocytoma with leptomeningeal dissemination (LMD) is described. A cerebellar tumor was diagnosed in a 3-year-old boy, in whom resection was performed. When the boy was 6 years of age, recurrence was treated with surgery and local radiotherapy. At age 13 years, scoliosis was present, but the patient was asymptomatic. Twelve years after initial surgery LMD was demonstrated in the lumbar spinal region without recurrence of the original tumor. This tumor also was subtotally removed. During the procedure, a hematoma was observed adjacent to the tumor, but the border was clear. Histological examination of the spinal cord tumor showed features similar to those of the original tumor. There were no tumor cells in the hematoma. The MIB-1 labeling index indicated no malignant change compared with the previous samples. Radiotherapy was performed after the surgery. The importance of early diagnosis and management of scoliosis is emphasized, and the peculiar pattern of dissemination of the pilo-cytic astrocytoma and its treatment are reviewed.

Posterior tibial nerve somatosensory cortical evoked potentials in adolescent idiopathic scoliosis

STUDY DESIGN

Somatosensory-evoked potentials were used to evaluate neurologic function in patients with adolescent idiopathic scoliosis.

OBJECTIVES

To compare the somatosensory-evoked potentials between patients with adolescent idiopathic scoliosis and healthy control individuals, and to determine the incidence of abnormal somatosensory function in patients with adolescent idiopathic scoliosis.

SUMMARY OF BACKGROUND DATA

Somatosensory-evoked potentials are sensitive in detecting structural lesions in the somatosensory pathway. Previous studies on somatosensory function in patients with idiopathic scoliosis have demonstrated statistical differences in somatosensory-evoked potential latency between scoliotic and normal groups. However, no documentation of the actual incidence of abnormal somatosensory-evoked potentials is available.

SUBJECTS AND METHODS

Posterior tibial nerve somatosensory cortical evoked potentials were evaluated on 147 young patients with adolescent idiopathic scoliosis and 31 healthy control individuals.

RESULTS

Seventeen patients with idiopathic scoliosis showed pathologic evoked potentials. Among them were seven with absent somatosensory-evoked potential waveform and 10 with delayed latency. The results were reproducible on repeated measurement.

CONCLUSIONS

Adolescent idiopathic scoliosis could be subdivided according to the somatosensory-evoked potential findings into two subgroups, those with and those without a somatosensory pathologic process. Potential clinical significance in predicting curve progression in idiopathic scoliosis could be pursued further.