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Abstract

Thirty consecutive patients with congenital spinal deformity underwent magnetic resonance imaging (MRI) to determine the incidence of occult intraspinal anomaly. These congenital spinal deformities included 29 cases of congenital scoliosis and one case of congenital kyphosis. Physical examination findings and plain radiographs were reviewed in an attempt to correlate these findings with subsequent intraspinal pathology. Nine patients had intraspinal anomalies identified on MRI consisting of five with tethered cord, four with syringomyelia, three with lipoma, and one with diastematomyelia. One patient required surgery for diastematomyelia; another underwent release of his tethered cord. Only one patient, with diastematomyelia associated with a syrinx and bifocal tethering, had his anomaly suggested by physical examination and plain radiographs. Two other patients had findings on plain radiographs previously associated with high prevalence of occult intraspinal anomalies; one patient with congenital kyphosis had a tethered cord, and one patient with a unilateral hemivertebrae associated with a contralateral bar had a tethered cord. Two of nine patients with occult intraspinal anomalies required surgery for their anomaly. In patients with a congenital spinal deformity, we found nine (30%) of 30 to have an associated anomaly within the spinal canal. Only three of these nine had plain radiographs and physical examination findings suggestive of their subsequent MRI findings. Given the poor correlation between findings on physical examination, plain radiographs, and subsequent occult intraspinal anomalies on MRI, we believe that MRI is helpful in evaluating patients with congenital spinal anomalies.

Split Spinal Cord Malformation: Report of 5 Cases in a Single Chinese Center and Review of the Literature

“…Prahinski et al [25] reported 9 cases with intraspinal abnormalities after MRI screening of 30 cases of CS. Only 3 of these 9 had plain radiographs and physical examination findings suggestive of their intraspinal abnormalities.…”

“…Therefore, the priority for a patient suspected of having SSCM should be CTM examination. With the evolution and further accessibility of modern neuroimaging techniques, this condition is becoming more frequently diagnosed [24,25,26,27,28]. Pang et al [9,20] recommended that MRI should be performed in patients with myelomeningocele with unusual clinical features, such as inconsistencies between placode and neurological level and right-left asymmetries.…”

“…As the risk of developing neurological deficits increases with age, all patients should be surgically treated prophylactically even if asymptomatic [8]. Type I and II SSCMs are equally likely to cause neurological deficits and thus should all be surgically explored [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. However, Miller et al [6] reported that observation of patients with diastematomyelia who had either no deficit or a stable, non-progressing deficit indicated that observation was recommended.…”

Concurrent Tethered Cord Release and Growing-Rod Implantation—is it Safe?

“…Numerous studies have shown that 20 to 40% of children with either congenital,1 2 3 4 5 infantile,6 or juvenile7 8 scoliosis have a spinal cord abnormality on preoperative MRI studies. Many of these will require neurosurgical intervention.…”

“…2 3 4 5 6 7 8 Historically, patients with scoliosis associated with a tethered cord were treated in a staged fashion, with a tethered cord release first, followed by scoliosis correction 6 weeks to 6 months later, due to concerns of neurological injury 39 10 11 Recent advances in neurophysiological monitoring techniques, however, have greatly increased the margin of safety for procedures with the potential for neurological injury.…”