Prevalence and clinical relevance of underlying pathological conditions in painful adolescent idiopathic scoliosis: a MRI-based study


Study design

Cross-sectional comparative study.


Evaluate prevalence and clinical relevance of an underlying pathology in painful adolescent idiopathic scoliosis (AIS) patients after a non-diagnostic history, physical examination and spinal X-ray using Magnetic Resonance Image (MRI) as diagnostic tool.

Summary of background data

Discrepancies regarding indications of routine MRI screening in painful AIS patients are multifactorial. Few studies have investigated relationship and practical importance of painful AIS with an underlying pathology by MRI.


A total of 152-consecutive AIS patients complaining of back pain during a 36-month period were enrolled. All patients underwent whole-spine MRI after a non-diagnostic history, physical examination and spinal X-ray. Underlying pathologies were reported as neural and non-neural axis abnormalities based on MRI reports. Variables such as sex, age, constant or intermittent pain, night pain, back pain location (thoracic or lumbar pain), Cobb-angle and follow-up were evaluated as clinical markers to predict presence of underlying MRI pathologies.


The presence of an underlying pathology was found by MRI in 54 painful AIS patients (35.5%). Isolated syringomyelia was the only neural axis abnormality found in 6 patients (3.9%). Non-neural axis abnormalities (31.6%) were composed by: 32 herniated nucleus pulposus, 5 vertebral disc desiccation, 4 ovarian cysts, 3 renal cysts, 2 sacral cysts, and 2 vertebral hemangiomas. There was no association with gender, age of presentation, initial coronal Cobb angle and follow up; with presence of an underlying pathology. Lumbar pain location was identified as an adequate clinical marker that correlated with presence of an underlying pathology (p = 0.01).


Prevalence of underlying pathologies diagnosed by MRI in painful AIS was found high (35.5%), but it’s clinical relevance and implication are debatable. The use of MRI did not affect orthopedic management of painful AIS patients who showed an underlying pathology. A thorough evaluation must be performed by clinicians; and discussed with patients and family prior to undergo further imaging management.

Level of evidence

Level III.

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This study did not receive any type of funding sources.

Author information




NR, GO, AC, LC, NR and II: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. NR, GO, AC, LC, NR and II: Drafting the work or revising it critically for important intellectual content. NR, GO, AC, LC, NR and II: Final approval of the version to be published.

Corresponding author

Correspondence to Norman Ramírez.

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Dr. Ramírez, Dr. Olivella, Dr. Cuneo, Dr. Carrazana, Mrs. Ramírez & Dr. Iriarte declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board committee of Ponce Research Institute (Protocol # 150320-NR) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ramírez, N., Olivella, G., Cuneo, A. et al. Prevalence and clinical relevance of underlying pathological conditions in painful adolescent idiopathic scoliosis: a MRI-based study. Spine Deform 8, 663–668 (2020).

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  • Back pain
  • Idiopathic scoliosis
  • Clinical marker