Imaging of Spine Disorders in Children: Dysraphism and Scoliosis

  • L. Santiago Medina
  • Diego Jaramillo
  • Esperanza Pacheco-Jacome
  • Martha C. Ballesteros
  • Tina Young Poussaint
  • Brian E. Grottkau

Key Points

Spinal Dysraphism

■ The prevalence of occult spinal dysraphism (OSD) ranges from as low as 0.34% in children with intergluteal dimples to as high as 46% in newborns with cloacal malformation (moderate evidence).

Radiographs are relatively insensitive and nonspecific for this diagnosis. MRI and ultrasound have high overall diagnostic performances (i.e., sensitivity and specificity) in children with suspected OSD (moderate evidence).

■ Early detection and prompt neurosurgical correction of OSD may prevent upper urinary tract deterioration, infection of dorsal dermal sinuses, or permanent neurologic damage (moderate and limited evidence).

■ Cost-effectiveness analysis suggests that, in newborns with suspected OSD, appropriate selection of patients and diagnostic strategy may increase quality-adjusted life expectancy and decrease cost of medical workup (moderate evidence).


■ Radiographic measurements of scoliosis are reproducible, particularly when the levels of the end plates measured are kept constant (moderate evidence). Unexpected findings on radiographs are unusual (limited evidence).

■ Radiographic monitoring of scoliosis results in a clear increase in the radiation-induced cancer risk, particularly to the female breast (moderate evidence). It also results in a high dose of radiation to the ovaries and worsens reproductive outcome in females (moderate evidence). Therefore, it is very important to reduce the radiation exposure. Posteroanterior projection greatly reduces exposure. Some digital systems also decrease radiation.

■ Significant controversy exists on the use of MRI in “idiopathic” scoliosis. MRI is recommended for children at higher risk of CNS lesions: (1) patients with idiopathic scoliosis and an abnormal neurological exam; (2) children under the age of 11 years; and (3) patients with levoconvex or atypical curves (limited to moderate evidence). However, exceptions to these rules have been reported in the literature (limited to moderate evidence). Therefore, patients with scoliosis considered for surgical intervention should have preoperative MRI to avoid the potential irreversible neurological complications that could occur if any underlying CNS lesion was undetected or misdiagnosed.


Adolescent Idiopathic Scoliosis Idiopathic Scoliosis Moderate Evidence Tethered Cord Congenital Scoliosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • L. Santiago Medina
    • 1
  • Diego Jaramillo
    • 2
  • Esperanza Pacheco-Jacome
    • 3
  • Martha C. Ballesteros
    • 3
  • Tina Young Poussaint
    • 4
  • Brian E. Grottkau
    • 5
  1. 1.Division of Neuroradiology and Brain Imaging, Director of the Health Outcomes, Policy, and Economics (HOPE) Center, Department of RadiologyMiami Children’s HospitalMiamiUSA
  2. 2.Department of Radiology, The Children’s Hospital of Philadelphia, Professor of Radiology, Department of RadiologyUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Department of RadiologyMiami Children’s HospitalMiamiUSA
  4. 4.Department of Radiology, Harvard Medical School, Attending Neuroradiologist, Department of RadiologyChildren’s Hospital BostonBostonUSA
  5. 5.Department of Orthopaedic SurgeryMassachusetts General Hospital for Children/Harvard Medical SchoolBostonUSA

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