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Najib KS, Razavinejad SM, Yarmahmoodi F, Barzegar H. Unilateral diaphragmatic paralysis and complete brachial plexus injury in a complex birth injury: A rare case report mimicking Tarlov cyst and review of literature. Clin Case Rep 2024; 12:e8406. [PMID: 38173882 PMCID: PMC10762482 DOI: 10.1002/ccr3.8406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
The rare occurrence of Tarlov cysts in pediatric patients, particularly in the context of complex birth injuries, necessitates thorough evaluation and tailored management approaches. A comprehensive understanding of the clinical significance and optimal treatment strategies for this unique combination is crucial to ensure effective and individualized care for affected children.
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Affiliation(s)
| | | | - Fatemeh Yarmahmoodi
- Assistant Professor of Radiology, Medical Imaging Research CenterShiraz University of Medical SciencesShirazIran
| | - Hamide Barzegar
- Neonatal Research CenterShiraz University of Medical SciencesShirazIran
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Shimauchi-Ohtaki H, Honda F, Nakamura S, Yoshimoto Y. Severe constipation due to sacral perineural cysts in a pediatrics patient: A case report. Surg Neurol Int 2022; 13:317. [PMID: 35928307 PMCID: PMC9345110 DOI: 10.25259/sni_1152_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Symptomatic perineural cysts are rare in pediatric patients. Severe bowel dysfunction caused by the perineural cysts at the sacral level is particularly rare in children. Moreover, the long-term outcome of surgery for the perineural cysts in pediatric patients is uncertain. Here, we describe a rare case of perineural cysts originating in the S3 roots in a pediatric patient that manifested as severe constipation. Case Description: The case was a 13-year-old girl who presented with intractable vomiting and constipation. She also had low back and buttock pain, urinary incontinence, and periproctal sensory disturbance. Radiological studies revealed bilateral perineural cysts originating from the S3 nerve roots, which were considered to be the cause of her symptoms. Microsurgical decompression of the cysts relieved her intractable bowel dysfunction. There has been no recurrence in the 5 years since surgery. Conclusion: This case suggests that microsurgery for severe bowel dysfunction due to symptomatic perineural cysts could have a satisfactory long-term outcome in pediatric patients.
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Azzouzi H, Ichchou L. Schmorl's nodes: demystification road of endplate defects-a critical review. Spine Deform 2022; 10:489-499. [PMID: 34825353 DOI: 10.1007/s43390-021-00445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schmorl's nodes (SN) were the first vertebral endplate defects described. Debate continues about their epidemiology, physiopathology, and clinical significance. The purpose of this work was to summarize and discuss available literature about SN. METHODS We have searched for relevant papers about SN until April 2020, with 104 articles have been reviewed. RESULTS More than half of the available literature described the epidemiological aspects of SN or reported rare clinical presentations and treatment options. The lack of a consensual definition of SN, among other endplate defects, contributed to difficulties in literature results' interpretation. Summing up, SN is a frequent vertebral defect at the thoracolumbar juncture, with ethnic and gender influence. Lumbar Schmorl's nodes were frequently associated with disc degenerative disease and back pain. Their physiopathology remains unknown. However, strain energy changes in the spine along with morphological aspects of the vertebra, the genetic background, and the osteoimmunology may constitute possible clues. New SN could be confused in malignancy context with bone metastasis. The literature describes some imaging techniques to differentiate them, avoiding invasive approaches. Treatment options for rare painful presentations remain few with low evidence. Further studies are needed to establish a consensual definition for SN, understand clinical aspects, and provide adequate therapeutic strategies.
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Affiliation(s)
- Hamida Azzouzi
- Department of Rheumatology, Faculty of Medicine, Mohammed VI University Hospital of Oujda, Université Mohammed Premier, Oujda, Morocco.
| | - Linda Ichchou
- Department of Rheumatology, Faculty of Medicine, Mohammed VI University Hospital of Oujda, Université Mohammed Premier, Oujda, Morocco
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Johnson MA, Gohel S, Mitchell SL, Flynn JJM, Baldwin KD. Entire-spine Magnetic Resonance Imaging Findings and Costs in Children With Presumed Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2021; 41:585-590. [PMID: 34411047 DOI: 10.1097/bpo.0000000000001943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with adolescent idiopathic scoliosis (AIS) are commonly monitored for curve progression with spinal radiographs; however, the utility of magnetic resonance imaging (MRI) screening is unclear. The purpose of this study was to assess the findings of screening MRI for patients with a nonsurgical curve size ordered during routine clinical care and compare them with MRI ordered for patients with large curves as part of preoperative screening. METHODS All consecutive patients with presumed AIS who underwent entire-spine MRI with a presumed diagnosis of idiopathic scoliosis at a single institution between 2017 and 2019 were retrospectively reviewed. Patients were stratified based on MRI indication into the following groups: preoperative evaluation, pain, neurological symptoms, abnormal radiographic curve appearance, rapidly progressive curve, and other. Neural axis abnormalities recorded included concern for tethered spinal cord, syringomyelia, and Chiari malformation. The MRI findings of preoperative patients with large curves were compared with all other patients. The number needed to diagnose (NND) a neurological finding was calculated in patients whose MRIs were ordered during routine clinical care. The amount charged for each patient undergoing entire-spine MRI was determined by review of our institution's Financial Decision Support system. RESULTS There were 344 patients included in this study with 214 (62%) MRIs performed for preoperative evaluation. Although MRI abnormalities were found in 49% of patients, only 7.0% (24/344) demonstrated neural axis abnormalities with no difference between preoperative and other indications (P=0.37). For patients with nonsurgical curves undergoing MRI due to a complaint of back pain (n=28), there were no neural axis abnormalities, and a lower rate of disk herniation/degenerative changes detected compared with preoperative MRI (3.6% vs. 18%, P=0.06). Among the 15 patients undergoing MRI for a neurological concern, 1 had a neural axis abnormality that required surgical detethering. The NND for MRI to detect a neural axis abnormality that potentially required neurosurgical intervention in nonpreoperative patients with a neurological concern was 34.4. The average cost for MRI was $17,816 (range: $2601 to $22,411) with a total cost of $2,368,439 for nonsurgical curves. CONCLUSIONS Entire-spine MRI for nonpreoperative indications including pain, abnormal radiographic curve appearance, and rapid curve progression has minimal utility for patients with AIS. For patients with neurological complaints, the NND a potentially treatment-altering finding with MRI is 34.4. LEVEL OF EVIDENCE Level II-diagnostic.
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Affiliation(s)
- Mitchell A Johnson
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Rathjen K, Dieckmann RJ, Thornberg DC, Karam A, Birch JG. Incidence and significance of findings on spinal MRIs in a paediatric population with spinal column complaints. J Child Orthop 2021; 15:70-75. [PMID: 33643461 PMCID: PMC7907767 DOI: 10.1302/1863-2548.15.200158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints. METHODS Surgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics. RESULTS The most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as 'clinically inconsequential'. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI.Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication 'curve magnitude at presentation' was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology. CONCLUSION Radiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years' younger than those with a normal or inconsequential MRI. 'Curve magnitude at presentation' in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. 'Pain' was the only indication significantly associated with clinically inconsequential findings on MRI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Karl Rathjen
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Correspondence should be sent to Karl E. Rathjen, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA. E-mail:
| | | | | | - AnnMarie Karam
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - John G. Birch
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
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Klepinowski T, Orbik W, Sagan L. Global incidence of spinal perineural Tarlov's cysts and their morphological characteristics: a meta-analysis of 13,266 subjects. Surg Radiol Anat 2021; 43:855-863. [PMID: 33452905 PMCID: PMC8164596 DOI: 10.1007/s00276-020-02644-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spinal perineural Tarlov's cysts (TCs) are considered incidental findings that occasionally might exert pressure upon nerve roots and correspond with patients' signs and symptoms. Purpose of this meta-analysis is to deliver global incidence and characteristics (location, size, and shape) of TCs. METHODS Following PRISMA checklist, all major databases were searched by two authors for radiologic studies reporting incidence and morphologic features (location, size, and shape) of TCs. Anatomical Quality Assessment tool was applied for risk of bias evaluation. Meta-analysis of random-effects model was employed. Subgroup analysis for regional distribution, gender, sacral levels, age, correspondence with symptoms, and persistent genital arousal disorder (PGAD) were planned ahead. RESULTS 22 radiologic studies of level 3 evidence involving 13,266 subjects were included. Global pooled prevalence of TCs was 4.18% (95% CI 2.47-6.30). Mean pooled sagittal diameter was 11.86 mm (95% CI 10.78-12.93). Sacral cysts strongly prevailed over the other segments. Of the sacral, S2 level was the most common (46.7% [95% CI 29.4-60.5]). Geographically, the highest incidence was found in Europe (6.07% [95% CI 1.49-13.00]), followed by North America (3.82% [95% CI 0.49-9.44]), and Asia (3.33% [95% CI 1.52-5.75]). TCs were more common in women than in men (5.84% vs 3.03%, p < 0.001, test of homogeneity, χ2). Subjects with PGAD had incidence of 37.87% (95% CI 2.45-81.75). TCs in pediatric population are rare-0.53% (95% CI 0.02-1.51). 15.59% of TCs corresponded with symptoms. CONCLUSIONS Spinal perineural (Tarlov) cysts are found in a minority of population. S2 level of the sacral bone is affected most frequently. There is female predominance. Correspondence with symptoms is seen in less than one-fifth of TCs. Studies with stronger evidence level are needed to corroborate the results. The purported high incidence in PGAD requires confirmation in case-control studies for the risk-ratio calculation.
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Affiliation(s)
- Tomasz Klepinowski
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland.
| | - Wojciech Orbik
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
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Extraspinal findings prevalence and clinical significance in 4250 lumbar spine MRI exams. Sci Rep 2021; 11:1190. [PMID: 33441940 PMCID: PMC7806849 DOI: 10.1038/s41598-021-81069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
To assess extraspinal findings (ESFs) prevalence in lumbar spine MRI, including clinically significant findings using a systematic approach, and to determine their reporting rate. Lumbar spine MRI scans were retrospectively reviewed over 18 months by two radiologists. Reading discrepancies were resolved by consensus. ESFs were classified according to the involved system, clinical diagnosis, and clinical significance. The reporting rate was estimated by referring to the original report. There were 1509 ESFs in 1322/4250 patients with a substantial agreement between the two radiologists (kappa = 0.8). Almost half (621/1322) were in the 45–60 age group. Females represented 56.6% (748/1322). 74.2% (1120/1509) of the ESFs involved the urinary system among which 79.6% (892/1120) were renal cysts. Clinically significant findings represented 8.7% (131/1509) among which hydronephrosis represented 23% (30/131). First time detected malignant lesions represented 4.6% (6/131). ESFs reporting rate was 47.3%. 58.8% of the clinically significant ESFs were not reported. ESFs prevalence was 31.1%. The Urinary system was the most commonly involved. Most ESFs were benign warranting no further workup. However, clinically significant ESF were not infrequently detected. More than half of the clinically significant findings were not reported. A systematic review of MRI images is highly recommended to improve patient’s outcome.
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Daher RT, Daher MT, Daher RT, Rabahi MF, Fernandes MR, Gama HPP. Magnetic resonance imaging of the spine in a pediatric population: incidental findings. Radiol Bras 2020; 53:301-305. [PMID: 33071373 PMCID: PMC7545738 DOI: 10.1590/0100-3984.2018.0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To determine the prevalence of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic and lumbar spine in a paediatric population. Materials and Methods: We evaluated 190 spinal MRI examinations of patients aged ≤ 18 years of age. The study included only patients for whom complete medical records were available and who underwent complete MRI examination of the cervical, thoracic or lumbar spine, including whole-spine sagittal T2-weighted sequences. Imaging findings not related to the symptom or indication for MRI were considered incidental findings. Results: Of the 190 MRI examinations evaluated, 110 were in women and 80 were in men. The mean age of the study population was 12.46 ± 3.68 years. The main clinical indications for MRI in the sample were lumbago, scoliosis, dorsalgia and cervicalgia. Incidental findings were detected in the cervical, thoracic and lumbar spine in 40 (21.05%), 26 (13.83%) and 43 (22.63%) of the patients, respectively. The most common were (in the cervical spine) reversal/correction of the normal curvature; (in the thoracic spine) intravertebral disc herniation (Schmorl’s node) and disc dehydration; and (in the lumbar spine) disc protrusion (12 cases), Schmorl’s node (5 cases) and spondylolysis (4 cases). Conclusion: Incidental findings on MRI of the spine are less common in the paediatric population than in the adult population. Nevertheless, careful clinical evaluation of paediatric patients with complaints of axial and radiating pain is necessary in order to determine the correlation between symptoms and imaging findings.
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Affiliation(s)
- Renato Tavares Daher
- Universidade Federal de Goiás (UFG), Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Brazil
| | - Murilo Tavares Daher
- Universidade Federal de Goiás (UFG), Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Brazil
| | - Ricardo Tavares Daher
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Brazil; CRD Medicina Diagnóstica, Brazil
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Zidan MMA, Hassan IA, Elnour AM, Mahmoud MZ, Alghamdi MA, Salih M, Elhaj M, Ali WM. Incidental Extraspinal Findings in the Thoracic Spine during Magnetic Resonance Imaging of Intervertebral Discs. J Clin Imaging Sci 2019; 9:37. [PMID: 31538035 PMCID: PMC6737441 DOI: 10.25259/jcis_50_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/24/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this research was to determine the frequency of incidental extraspinal findings in the thoracic spine on magnetic resonance imaging (MRI). Materials and Methods: A total of 120 thoracic spine MRI patients were prospectively examined in the period extending from August 2018 to April 2019. Both 1.5 and 0.35 Tesla MRI systems (Toshiba and Siemens Medical system) were applied to investigate patients with suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum, Sudan. Results: Out of the 120 patients, incidental extraspinal findings were found in 16 patients (13.3%). Various incidental findings (IFs) were seen, including renal cysts, liver mass, thyroid goiter, and pleural effusion. Out of these IFs, 37.5% were considered clinically significant. Conclusions: Various IFs were identified during a routine thoracic spine MRI, and approximately one-third of them were clinically significant. Therefore, it is essential for the reporting radiologists to pay attention to extraspinal findings while reporting thoracic spine MRI to avoid missing clinically significant findings.
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Affiliation(s)
- Mogahid M A Zidan
- Diagnostic Radiology Department, Faculty of Radiology and Nuclear Medicine Sciences, The National Ribat University, Sudan
| | - Ikhlas A Hassan
- Diagnostic Radiologic Technology Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Abdelrahaman M Elnour
- Diagnostic Radiology Department, Faculty of Radiology and Nuclear Medicine Sciences, The National Ribat University, Sudan
| | - Mustafa Z Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj
| | - Mohammed A Alghamdi
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj
| | - Mohammed Salih
- Medical Imaging Technology Department, Al-Ghad International College for Applied Medical Sciences, Abha
| | - Mona Elhaj
- Medical Imaging Technology Department, Al-Ghad International College for Applied Medical Sciences, Al-Dammam, Saudi Arabia
| | - Wadah M Ali
- Medical Imaging Department, College of Health Science, Gulf Medical University, Ajman, United Arab Emirates
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Are Constant Pain, Night Pain, or Abnormal Neurological Examination Adequate Predictors of the Presence of a Significant Pathology Associated With Pediatric Back Pain? J Pediatr Orthop 2019; 39:e478-e481. [PMID: 30817418 DOI: 10.1097/bpo.0000000000001353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Previous studies have suggested that most cases of pediatric back pain do not have an identifiable cause. No reliable sign or indication differentiates between a benign or serious cause of the symptom. Constant pain, night pain, and abnormal neurological examination have been suggested as adequate predictors of an identifiable cause, when plain radiographs could not explain the symptoms. The purpose of this study is to determine the sensitivity, specificity, and likelihood ratios of constant pain, night pain, and abnormal neurological examination to predict the presence of an underlying positive finding as a cause of back pain. METHOD From 2010 to 2016, all patients who presented with a chief complaint of back pain were included in the study. Magnetic Resonance Image was performed to all patients presenting with back pain without identifiable cause lasting >4 weeks. Patients who presented with spondylolysis were treated accordingly base on radiographic findings and were excluded as study protocol. RESULTS A total of 388 patients were evaluated during the study period. The mean age of the subjects was 14.5 years; 69.7% being female. An underlying pathologic condition was identified in 56 of 132 (42%) of patients with constant pain, 61 of 162 (38%) with night pain, and 8 of 9 (89%) with abnormal neurological examination. Probability to have an underlying pathology correlated directly with the amount of clinical markers. DISCUSSION An abnormal neurological examination was found as a strong predictor for an underlying pathologic condition. Further imaging of a pediatric patient with back pain without clear explanation for their symptoms on plain radiographs should not be limited to constant pain, or night pain because clinicians could be missing important diagnosis. Therefore, the clinician cannot be assured by absence of these clinical markers, that there is no underlying spinal pathology. LEVEL OF EVIDENCE Level III.
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Hiremath SB, Boto J, Regnaud A, Etienne L, Fitsiori A, Vargas MI. Incidentalomas in Spine and Spinal Cord Imaging. Clin Neuroradiol 2019; 29:191-213. [PMID: 30887091 DOI: 10.1007/s00062-019-00773-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
Incidentalomas are common in magnetic resonance imaging (MRI) of the spine. These incidental findings (IFs) can be seen involving the spinal cord, nerve root, vertebral body, posterior arch and the extraspinal region. This review article describes the imaging findings, stratifies the IFs similar to the computed tomography (CT) colonography reporting and data system and briefly mentions the current recommendations for further evaluation and management of IFs. Radiologists are the first to detect these lesions, suggest further evaluation and management of IFs. It is therefore mandatory for them to be aware of recommendations in clinical practice in order to avoid increased patient anxiety, excessive healthcare expenditure and inadvertent therapeutic procedures.
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Affiliation(s)
- Shivaprakash B Hiremath
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - José Boto
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Alice Regnaud
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Léonard Etienne
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Aikaterini Fitsiori
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland.
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