Prevalence and risk factors for neural axis anomalies in idiopathic scoliosis: a systematic review.

Publication date: Available online 14 February 2018
Source:The Spine Journal
Author(s): Johan L. Heemskerk, Moyo C. Kruyt, Dino Colo, René M. Castelein, Diederik H.R. Kempen
BackgroundThere is ongoing controversy about the routine use of magnetic resonance imaging (MRI) preoperatively in patients with presumed idiopathic scoliosis (IS). Routine MRI can help identify possible causes for the deformity and detect anomalies which could complicate deformity surgery. However, routine MRI increases health care costs significantly and may reveal mild variations from normal without clinical relevance, that can still lead to anxiety and influence decision making.PurposeGiven the necessity to make evidence based decisions both in the light of quality of care as well as cost control, the aim of this review is to report the prevalence of neural axis anomalies in idiopathic scoliosis and to identify risk factors associated with these anomalies.Study design: systematic reviewMethodsAn electronic search until May 2017 PubMed, Embase, Cochrane and Cinahl was performed. Studies were assessed by 2 reviewers independently according to predetermined inclusion (MRI in presumed IS) and exclusion criteria (other diagnosis than IS).ResultsFifty one studies were included consisting 8622 patients. In 981 patients, anomalies were found, resulting in an overall prevalence of 11.4%. The prevalencewas10.5%, 9.0% and 14.2% when screening was performed of all IS patients, pre-operative patients or patients with for presumed risk factors.. The prevalence of a syrinx (3.7%), an Arnold-Chiari malformation (3.0%) or a combination of both (2.5%) was highest. Less frequent diagnoses included tethered cord (0.6%), an incidental malignancy (0.3%) and split cord malformations (0.2%). Risk factors for intraspinal anomalies included early onset scoliosis, male gender, atypical curves, thoracic kyphosis and abnormal neurological findings such as reflexes and sensation.ConclusionsThis systematic review shows that a significant number of patients have intra-spinal anomalies on preoperative MRI in (presumed) IS. The prevalence of finding spinal axis abnormalities increases in pre-selected patients groups with specific risk factors.



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