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European Spine Journal

, Volume 12, Issue 5, pp 501–506 | Cite as

Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients

  • Oliver N. Hausmann
  • Thomas Böni
  • Christian W. A. Pfirrmann
  • Armin Curt
  • Kan MinEmail author
Original Article

Abstract

This is a prospective study of spinal magnetic resonance imaging (MRI), electrophysiological recordings, and neurological examinations of 100 patients admitted for surgery for adolescent idiopathic scoliosis (AIS), which was conducted to assess the prevalence of structural and functional abnormalities within the spinal cord in patients with clinically normal neurologic condition. In all patients the clinical diagnosis and intact neurological condition was ascertained by a spinal orthopedic surgeon. Full-length spinal axis MRI studies (T1/T2 sequences) and somato-sensory evoked potentials of the tibial nerves (tSSEPs) were preoperatively assessed by independent evaluators blinded to the patients' medical histories. Structural spinal cord abnormalities were found in three of 100 AIS patients on MR imaging. In one patient a Chiari malformation type 1 with an accompanying syringomyelia was diagnosed, which required a suboccipital decompression. In the other two patients small thoracic syringomyelias were diagnosed. Abnormalities of spinal cord function were detected in 68% of the 100 patients: tSSEP latencies corrected for body height were increased in 56% of the patients; pathological differences between tSSEPs on the left and right sides were present in 17% (12% in combination with a prolongation of the latency). The findings of this study indicate that MRI and electrophysiological examinations are essential to assess spinal cord abnormalities that are clinically not detectable in AIS patients. Even in patients with intact neurologic condition and clinically typical right-curved thoracic scoliosis, the possibility of intraspinal pathologies should be ruled out by MRI. It is especially important to detect structural pathologies like syringomyelia and Chiari malformation before proceeding with scoliosis surgery, as these conditions are associated with a higher neurological risk during scoliosis surgery. The electrophysiological recordings made in the present study, with the high number of pathological tSSEPs, are indicative of functional abnormalities with a subclinical involvement of the recorded neuronal pathways. The relevance of the latter findings is not yet clear, but pre-operative tSSEP examinations offer the possibility of assessing alterations in spinal cord function that are undetectable by clinical examination.

Keywords

Idiopathic scoliosis MRI Tibial SSEP Syringomyelia 

References

  1. 1.
    Baker AS, Dove J (1983) Progressive scoliosis as the first presenting sign of syringomyelia. J Bone Joint Surg Br 65:472–473PubMedGoogle Scholar
  2. 2.
    Do T, Fras C, Burke S, Widmann R, Rawlins, Boachie-Adjei O (2001) Clinical value of routine preoperative magnetic resonance imaging in adolescent idiopathic scoliosis. J Bone Joint Surg Am 83:577–579Google Scholar
  3. 3.
    Charry O, Koop S, Winter R, Lonstein J, Denis F, Bailey W (1994) Syringomyelia and scoliosis: a review of twenty-five pediatric patients. J Pediatr Orthop 14:309–317PubMedGoogle Scholar
  4. 4.
    Cheng JC, Guo X, Sher AH (1998) Posterior tibial nerve somatosensory cortical evoked potentials in adolescent idiopathic scoliosis. Spine 23:332–337CrossRefPubMedGoogle Scholar
  5. 5.
    Emery E, Redondo A, Rey A (1997) Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: experience with 25 patients. Eur Spine J 6:158–162PubMedGoogle Scholar
  6. 6.
    Freund M, Hähnel S, Thompson M, Sartor K (2001) Treatment planning in severe scoliosis: the role of MRI. Neuroradiology 43:481–484CrossRefPubMedGoogle Scholar
  7. 7.
    Gupta R, Sharma R, Vashisht S, Ghandi D, Jayaswal AK, Dave PK, Berry M (1999) Magnetic resonance evaluation of idiopathic scoliosis: a prospective study: Australas Radiol 43:461–465Google Scholar
  8. 8.
    Hausmann O, Min K, Böni T, Erni T, Dietz V, Curt A (2003) SSEP in surgery of idiopathic scoliosis: the influence of spine deformity and surgical approach. Eur Spine J 12:117–123PubMedGoogle Scholar
  9. 9.
    Hugus JJ, McGee-Collett M, Besser M, Gurr KR, Taylor TK (1990) Scoliosis in syringomyelia: a new perspective. J Bone Joint Surg Br 72:1098Google Scholar
  10. 10.
    Majocco B, Deeney VF, Coulon R, Parks PF (1997) Adolescent idiopathic scoliosis and the presence of spinal cord abnormalities. Spine 22:2537–2541CrossRefPubMedGoogle Scholar
  11. 11.
    Mejia EA, Hennrikus WA, Schwend RM, Emans JB (1996) A prospective evaluation of idiopathic left thoracic scoliosis with magnetic resonance imaging. J Pediatr Orthop 16:354–358CrossRefPubMedGoogle Scholar
  12. 12.
    Muhonen MG, Menezes AH, Sawin PD, Weinstein SL (1992) Scoliosis in pediatric Chiari malformations without myelodysplasia. J Neurosurg 77:69–77PubMedGoogle Scholar
  13. 13.
    O'Brien MF, Lenke LG, Bridwell KH, Blanke K, Baldus C (1994) Preoperative spinal canal investigation in large adolescent idiopathic scoliosis curves (70°–140°): is it warranted? Spine 19:1606–1610Google Scholar
  14. 14.
    Ono A, Ueyama K, Okada A, Echigoya N, Yokoyama T, Harata S (2002) Adult scoliosis in syringomyelia associated with Chiari I malformation. Spine 27:E23–E28CrossRefPubMedGoogle Scholar
  15. 15.
    Osborn A (1994) Diagnostic neuroradiology. Mosby, St. LouisGoogle Scholar
  16. 16.
    Phillips WA, Hensinger RN, Kling TF (1990) Management of scoliosis due to syringomyelia in childhood and adolescence. J Pediatr Orthop 10:351–354PubMedGoogle Scholar
  17. 17.
    Shen WJ, McDowell GS, Burke SW, Levine DB, Chutorian AM (1996) Routine preoperative MRI and SEP studies in adolescent idiopathic scoliosis. J Pediatr Orthop 16:350–353CrossRefPubMedGoogle Scholar
  18. 18.
    Winter RB, Lonstein JE, Heithoff KB, Kirkham JA (1997) Magnetic resonance imaging evaluation of the adolescent patient with idiopathic scoliosis before instrumentation and fusion. Spine 22:855–858CrossRefPubMedGoogle Scholar
  19. 19.
    Zadeh HG, Sakka SA, Powell MP, Mehta MH (1995) Absent superficial abdominal reflexes in children with scoliosis. J Bone Joint Surg Br 77:762–767PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Oliver N. Hausmann
    • 1
  • Thomas Böni
    • 1
  • Christian W. A. Pfirrmann
    • 2
  • Armin Curt
    • 3
  • Kan Min
    • 1
    Email author
  1. 1.Department of Orthopedic Surgery, University Hospital BalgristUniversity of ZürichZurichSwitzerland
  2. 2.Department of Radiology, University Hospital BalgristUniversity of ZürichSwitzerland
  3. 3.ParaCare, Swiss Paraplegic Center, University Hospital BalgristUniversity of ZürichSwitzerland

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