Imaging in childhood scoliosis: a pictorial review

Musson, Rachel; Warren, Daniel; Bickle, Ian; Connolly, Daniel; Griffiths, Paul

doi:10.1136/pgmj.2009.089128

Cited by 19 publications

(13 citation statements)

References 22 publications

(25 reference statements)

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“…The main role of CT is to assess for any underlying occult pathology and for the pre-operative planning of scoliosis. There are currently no clear guidelines on which children with scoliosis should have the more advanced (and expensive) imaging methods [ 12 ].…”

Section: Computed Tomographymentioning

confidence: 99%

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

Ng¹,

Bettany‐Saltikov²

2017

TOORTHJ

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The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis.The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.

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Section: Computed Tomographymentioning

confidence: 99%

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

Ng¹,

Bettany‐Saltikov²

2017

TOORTHJ

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“…Neurologic deficit prior to the onset of treatment indicates an increased possibility of additional injury. This situation has been reported to be suggestive of brain stem and intraspinal anomalies [12][13][14][15][16][17][18]. In these patients, who have chronic ischemia and hypoxia of the spinal cord due to the spinal deformities, ''sick spinal cord'' which together with the abnormalities of the spinal cord or the canal, distraction or compression of the spinal cord following corrective maneuvers for the curve may lead to Fig.…”

Section: Clinical Factorsmentioning

confidence: 99%

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

et al. 2013

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Purpose To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery. Methods A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10-48 years). There were 52 adolescent patients (with an age \18 years) and 24 adult patients (with an age C18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis. Results No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P \ 0.05): location of apex at main curve (X 3 ), Cobb angle at the main curve at the coronal plane (X 4 ), scoliosis associated with thoracic hyperkyphosis (X 5 ), level of vertebral column resected (X 6 ), number of segmental vessels ligated (X 7 ), preexisting neurologic dysfunction (X 8 ), and associated with intraspinal and brain stem anomalies (X 9 ). The multi-factor unconditional logistic regression analysis revealed that X 8 (OR = 49.322), X 9 (OR = 18.423), X 5 (OR = 11.883), and X 6 (OR = 8.769) were independent and positively correlated with the neurologic deficit. Conclusions Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.

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“…3.57 atypical curve (such as levoconvex thoracic), developmental abnormalities such as neurofi bromatosis or Klippel-Feil syndrome, and for surgical clearing or to assess for postoperative complications [ 79 , 86 ]. Two to four percent of neurologically normal patients with idiopathic adolescent scoliosis have CNS abnormalities [ 87 -89 ], the most common being Arnold-Chiari I malformation, subtle syrinx, tethered cord, and fi lar lipoma [ 86 ]. In the absence of a neurologic defi cit, the fi rst two would usually not be treated [ 90 ].…”

Section: Imaging Techniquesmentioning

confidence: 99%

The Spine: Congenital and Developmental Conditions

Taragin

Wootton‐Gorges

2014

Pediatric Orthopedic Imaging

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The chapter initially discusses normal spinal development and variants. Pathology is addressed fi rst in terms of general structural vertebral anomalies. These are then applied to congenital scoliosis, kyphosis, and lordosis, as well as anomalies involving the craniovertebral junction. Discussion of spinal dysraphism follows, including tethered fi lum terminale, hydrosyringomyelia, and diastematomyelia. Congenital intraspinal tumors are briefl y reviewed. Klippel-Feil syndrome and caudal regression are presented, as well as spine manifestations of neurofi bromatosis and several other syndromes. Idiopathic scoliosis is discussed in detail, including curve measurement, imaging techniques, and treatment options. Neuromuscular scoliosis is briefl y reviewed. The chapter concludes with juvenile kyphosis.

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Imaging in childhood scoliosis: a pictorial review

Cited by 19 publications

References 22 publications

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

The Spine: Congenital and Developmental Conditions

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