Magnetic Resonance Imaging
- MRI is the modality of choice for assessment of the spinal canal and paraspinal soft tissues in patients with scoliosis. 4,12
- Spinal cord abnormalities are seen in 2-3% of patients with presumed adolescent idiopathic scoliosis. 9,13
- Abnormalities detected by MRI include Chiari malformations, hydromyelia, syringomyelia, intramedullary tumours, tethered spinal cord, diastamatomyelia and intra-spinal lipomas.
- The clinical relevance of these findings is still debated. It is known that there is increased risk of neurological complications during correction of scoliosis without prior neurosurgical intervention for conditions such as syringomyelia. 15
- Commonly accepted indications for MRI include
- Neurological findings
- Atypical curve pattern: examples are thoracic levoscoliosis, short segment curve (less than six segments), decreased vertebral rotation, rapid progression, and kyphosis near the apex of curve. Other features on scoliosis radiographs requiring MRI may be an underlying tumour or infection, widening of an intervertebral foramen or thickening of the paraspinal line. 17 In one study, there was a 25% prevalence of neuroaxis abnormalities when both an atypical curve and neurological findings were present. 9
- Age of onset <11 years: There is a higher prevalence (20%) of MRI neuroaxis abnormalities in the infantile/juvenile scoliosis age groups. 3
- The presence of abnormalities on MRI in those without any of the above features is variable depending on the series. Some studies report a 2-3% prevalence of which none required prior neurosurgical intervention or had postoperative neurological complications. 13,14 Others have reported prevalences up to 8% of which 15% required a neurosurgical procedure. 16 In view of this, some institutions advocate routine preoperative MRI in all patients with presumed adolescent idiopathic scoliosis.
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