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Intraspinal neural axis abnormalities in severe spinal deformity: a 10-year MRI review

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Abstract

Purpose

Documents indicated that the average prevalence of intraspinal neural axis abnormalities (INAAs) in presumed idiopathic scoliosis (PIS) patients was about 17.7%. However, paucity study focuses on the incidence of INAAs in severe spinal deformity (SSDs). In this study, we investigate the incidence of intraspinal neural axis abnormalities (IINAAs) and the clinical relevance in SSD at a single center.

Methods

All the patients with SSDs admitted for spinal surgery were evaluated from 2003 to 2014. Inclusion criteria: patients who present with coronal Cobb over 90° (and/or the sagittal Cobb ≥ 90°); patients with whole spine magnetic resonance imaging (MRI) done preoperatively; and patients with documented clinical findings preoperatively. Exclusion criteria: ankylosing spondylitis, adult onset scoliosis, scoliosis secondary to bone destruction, and spinal dysraphism.

Results

101 patients fulfilled the criteria were included. 43 patients were detected with INAAs (42.6%, 43/101). The most common INAAs was syrinx (S) (16/43, 37.2%). Of which, 43.7% (7/16), 37.5% (6/16), and 18.7% (3/16) were spindle, slit, and swelling types, respectively. Most of them were located in thoracic (6/16, 37.5%) and cervical (5/16, 31.3%) region. MRI revealed Chiari malformation with syringomyelia (C + S) in ten patients (10/43, 23.2%), Chiari malformation (C) in 6 patients (6/43, 13.9%) and others in 11 patients (11/43, 25.6%). As to the etiology, most patients with INAAs were PIS (34/43, 79.1%). On clinical examination, 16 of 101 patients (16/101, 15.8%) had abnormal neurologic signs. 15 of 16 patients (15/16, 93.7%) with abnormal neurologic signs had INAAs on MRI. On the other hand, 28 of 43 patients (28/43, 65.1%) with INAAs on MRI presented neurologically intact. 28 of 85 patients (28/85, 32.9%) with neurologically intact were detected with INAAs on MRI.

Conclusion

The incidence of INAAs in SSDs was 42.6%. 65.1% of them present intact neurologic status. The most common neural anomaly was syrinx. Preoperative whole spine MRI must be beneficial for SSDs even in the absence of neurological findings.

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Acknowledgements

The manuscript submitted does not contain information about medical device(s)/drug(s). Fund from the Joint Special Fund of Kunming Medical (Grant No. 2015FB053) was received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People’s Republic of China

    Ying Zhang, Jingming Xie, Yingsong Wang, Ni Bi, Tao Li, Jie Zhang, Zhi Zhao, Hua Ou & Siyuan Liu

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  1. Ying Zhang
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  2. Jingming Xie
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  3. Yingsong Wang
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  4. Ni Bi
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  6. Jie Zhang
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  8. Hua Ou
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  9. Siyuan Liu
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Correspondence to Jingming Xie.

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Zhang, Y., Xie, J., Wang, Y. et al. Intraspinal neural axis abnormalities in severe spinal deformity: a 10-year MRI review. Eur Spine J 28, 421–425 (2019). https://doi.org/10.1007/s00586-018-5522-3

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  • DOI: https://doi.org/10.1007/s00586-018-5522-3

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