Variation in Anisotropy and Diffusivity along the Medulla Oblongata and the Whole Spinal Cord in Adolescent Idiopathic Scoliosis: A Pilot Study Using Diffusion Tensor Imaging

Abstract

BACKGROUND AND PURPOSE:Disturbed somatosensory evoked potentials have been demonstrated in patients with adolescent idiopathic scoliosis (but this functional delay was found to originate above the C5-6 level, while the lower cord level was unaffected). Together with MR imaging observation of tonsillar ectopia and a relatively tethered cord, we hypothesized that there is disturbed mean diffusivity integrity along the spinal cord. In this study, advanced DTI was used to evaluate whether there was underlying decreased WM integrity within the brain stem and spinal cord in adolescent idiopathic scoliosis and any relationship to cerebellar tonsillar ectopia. Clinical impact on balance testing was also correlated.

Bi-planar spinal stereoradiography of adolescent idiopathic scoliosis: considerations in 3D alignment and functional balance

“…Higher postural stability is preferable for patients who have difficulty maintaining their balance e.g. adults with disability and some pre-operative AIS [28,29]. Considerations are needed for a patient's positioning in each position.…”

Electrophysiological and histological changes of paraspinal muscles in adolescent idiopathic scoliosis

“…In AIS, some authors have concentrated on muscle and peripheral nerve disturbances, but in other studies impairment of the spinal cord and different pattern of brain activation has been published [7][8][9]. These observations demonstrate that central nervous system involvement with abnormal sensorimotor integration may underlie the pathogenesis of idiopathic scoliosis [5,10].…”

Anatomical Origin of Abnormal Somatosensory-Evoked Potential (SEP) in Adolescent Idiopathic Scoliosis With Different Curve Severity and Correlation With Cerebellar Tonsillar Level Determined by MRI

“…20 Our finding might shed light on the pathoanatomical origin of abnormal SEP in AIS patients, particularly in patients with Cobb angle over 40 degrees. 18 …”

“…This provides further neurophysiological support to our previous finding on imaging. 20 Reports on the pre-operative SEP assessment on AIS patients with different severity were scarce. The results from 1 of the 2 reported studies with pre-operative electrophysiological and radiological evaluation in 100 adolescent patients admitted for surgery showed that SEP latency increased in 56% of the patients, and 3% of whom was found to have intraspinal abnormalities.…”

“…[9][10][11][12] Other studies have also found an association of abnormal postural balance and dynamic gait balance in AIS with abnormal SEP. 13,14 These observations might be partially explained by the relative anterior spine overgrowth coupling with relative shortening and subclinical tethering of the spinal cord in AIS. [15][16][17][18][19][20] There is limited information on SEP on milder scoliotic patients (Cobb's angle 10-39 degrees) in contrast to the majority data for the operated group with severe deformities. We speculate that there are differences in neurophysiological status in terms of amplitude and latency differences in SEP waveforms between scoliotic curves of different severity, and the SEP abnormality could increase with curve severity.…”