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MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

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Abstract

Study Design

Patients with preoperative spine magnetic resonance imaging (MRI) studies from a prospective multicenter study of operative adolescent Scheuermann kyphosis (SK).

Objectives

To investigate the usefulness of MRI screening in operative planning for SK surgeries.

Summary of Background Data

Neural axis abnormalities in operative SK have not been previously studied with MRI screening, despite its use.

Methods

One orthopedic surgeon and two radiologists evaluated all images retrospectively. Radiographs were evaluated for kyphosis apex and magnitude. MRIs were evaluated for spinal cord abnormalities, epidural lipomatosis, location and number of vertebral wedging, Schmorl nodes and posterior disc herniations, frequency of spondylolysis, etc. The relationship of these pathologies to the kyphosis apex was explored. This group was compared to a surgical SK group without preoperative MRIs.

Results

Eighty-six patients with MRIs, mean age 16.3 years, 64% male, and a mean preoperative kyphosis of 75.9° were evaluated. There were 17 spinal cord abnormalities. Low-lying conus was found in 2 patients, and syrinx in 15 (no Chiari malformations). Epidural lipomatosis was found in 49 patients, average of 5.7 levels. Anterior vertebral wedging occurred in all (mean 4.7 levels). Posterior disc herniations averaged 5.2 levels/patient and 1.8 levels caudad to the apex. Spondylolysis was reported in 8.1%. Four cases (4.7%) had the operative plan changed as a result of the preoperative MRI: two due to neural compression, one due to disc herniation and one due to a spinal cord draped over the apex. Thirty-one patients did not receive an MRI; there were no significant differences between the two groups. The rate of postoperative neurologic change was 3.5% in the MRI group and 3.2% in the no-MRI group.

Conclusions

Based on 4.7% of cases requiring a change in the operative plan as a result of preoperative MRI, the authors recommend considering performing screening MRI in operative SK patients.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mount Sinai Hospital, 820 Second Ave, Suite 7A, New York, NY, 10017, USA

    Baron S. Lonner MD

  2. School of Medicine, New York University, New York, NY, 10003, USA

    Courtney S. Toombs BA

  3. Department of Radiology, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY, USA

    Michael Mechlin MD & Gina Ciavarra MD

  4. Department of Orthopedics, Nemours/Alfred I duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  5. Shriner’s Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Amer F. Samdani MD & Randal R. Betz MD

  6. Division of Pediatric Orthopaedics, All Children’s Hospital at Johns Hopkins, 1800 Orleans St, Baltimore, MD, 21287, USA

    Paul Sponseller MD

  7. Division of Pediatric Spinal Surgery, Miami Children’s Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA

    Harry L. Shufflebarger MD

  8. Department of Orthopedic Surgery, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA

    Burt Yaszay MD & Peter O. Newton MD

Authors
  1. Baron S. Lonner MD
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  2. Courtney S. Toombs BA
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  3. Michael Mechlin MD
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  4. Gina Ciavarra MD
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  5. Suken A. Shah MD
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  6. Amer F. Samdani MD
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  7. Paul Sponseller MD
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  8. Harry L. Shufflebarger MD
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  9. Randal R. Betz MD
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  11. Peter O. Newton MD
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Corresponding author

Correspondence to Baron S. Lonner MD.

Additional information

Author disclosures

BSL (grants from DePuy Synthes, AO Spine, John and Marcella Fox Fund Grant, and OREF; personal fees from DePuy Synthes, K2M, DePuy Spine, and Mount Sinai Hospital, outside the submitted work; other from SRS Spine Deformity Journal, Paradigm Spine, Spine Search, DePuy Synthes, and Spine Search); CST (none); MM (none); GC (none); SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, K2M, NuVasive, outside the submitted work); AFS (grants from DePuy Synthes Spine, during the conduct of the study; personal fees from DePuy Synthes Spine, Stryker, Ethicon, Globus Medical, and Zimmer-Biomet, outside the submitted work); PS (personal fees from DePuy Synthes Spine, Globus, Journal of Bone and Joint Surgery, Oakstone Medical Publisher, outside the submitted work); HLS (royalties and grants from DePuy Spine); RRB (grants from DePuy Synthes Spine, during the conduct of the study; personal fees and other from Abyrx, Apifix, and SpineGuard; other from Advanced Vertebral Solutions, Medovex, MiMedx, and Orthobond; personal fees from DePuy Synthes Spine, Globus Medical, Medtronic, and Zimmer Biomet, outside the submitted work; and is employed by DePuy Synthes Spine); BY (reports grants from Setting Scoliosis Straight, during the conduct of the study; personal fees from DePuy Synthes, NuVasive, Globus, Stryker, Orthopediatrics, outside the submitted work; grants and personal fees from K2M; a patent K2M with royalties paid); PON (none).

A grant was received from DePuy Spine to Setting Scoliosis Straight Foundation in support of the Harms Study Group’s research.

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Lonner, B.S., Toombs, C.S., Mechlin, M. et al. MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?. Spine Deform 5, 124–133 (2017). https://doi.org/10.1016/j.jspd.2016.10.008

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  • DOI: https://doi.org/10.1016/j.jspd.2016.10.008

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