MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

Baron S Lonner; Courtney S Toombs; Michael Mechlin; Gina Ciavarra; Suken A Shah; Amer F Samdani; Paul Sponseller; Harry L Shufflebarger; Randal R Betz; Burt Yaszay; Peter O Newton

doi:10.1016/j.jspd.2016.10.008

MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

Spine Deform. 2017 Mar;5(2):124-133. doi: 10.1016/j.jspd.2016.10.008.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Mount Sinai Hospital, 820 Second Ave, New York, NY 10017, USA. Electronic address: blonner@scoliosisassociates.com.
² School of Medicine, New York University, New York, NY 10003, USA.
³ Department of Radiology, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY, USA.
⁴ Department of Orthopedics, Nemours/Alfred I duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA.
⁵ Shriner's Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.
⁶ Division of Pediatric Orthopaedics, All Children's Hospital at Johns Hopkins, 1800 Orleans St, Baltimore, MD 21287, USA.
⁷ Division of Pediatric Spinal Surgery, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA.
⁸ Department of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.

PMID: 28259264
DOI: 10.1016/j.jspd.2016.10.008

Abstract

Study design: Patients with preoperative spine magnetic resonance imaging (MRI) studies from a prospective multicenter study of operative adolescent Scheuermann kyphosis (SK).

Objectives: To investigate the usefulness of MRI screening in operative planning for SK surgeries.

Summary of background data: Neural axis abnormalities in operative SK have not been previously studied with MRI screening, despite its use.

Methods: One orthopedic surgeon and two radiologists evaluated all images retrospectively. Radiographs were evaluated for kyphosis apex and magnitude. MRIs were evaluated for spinal cord abnormalities, epidural lipomatosis, location and number of vertebral wedging, Schmorl nodes and posterior disc herniations, frequency of spondylolysis, etc. The relationship of these pathologies to the kyphosis apex was explored. This group was compared to a surgical SK group without preoperative MRIs.

Results: Eighty-six patients with MRIs, mean age 16.3 years, 64% male, and a mean preoperative kyphosis of 75.9° were evaluated. There were 17 spinal cord abnormalities. Low-lying conus was found in 2 patients, and syrinx in 15 (no Chiari malformations). Epidural lipomatosis was found in 49 patients, average of 5.7 levels. Anterior vertebral wedging occurred in all (mean 4.7 levels). Posterior disc herniations averaged 5.2 levels/patient and 1.8 levels caudad to the apex. Spondylolysis was reported in 8.1%. Four cases (4.7%) had the operative plan changed as a result of the preoperative MRI: two due to neural compression, one due to disc herniation and one due to a spinal cord draped over the apex. Thirty-one patients did not receive an MRI; there were no significant differences between the two groups. The rate of postoperative neurologic change was 3.5% in the MRI group and 3.2% in the no-MRI group.

Conclusions: Based on 4.7% of cases requiring a change in the operative plan as a result of preoperative MRI, the authors recommend considering performing screening MRI in operative SK patients.

Keywords: MRI; Scheuermann kyphosis; Spinal fusion.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Female
Humans
Intervertebral Disc Degeneration / diagnostic imaging*
Intervertebral Disc Degeneration / etiology
Intervertebral Disc Displacement / diagnostic imaging*
Intervertebral Disc Displacement / etiology
Lipomatosis / diagnostic imaging*
Lipomatosis / etiology
Magnetic Resonance Imaging / methods*
Male
Preoperative Care / methods*
Prospective Studies
Retrospective Studies
Scheuermann Disease / complications
Scheuermann Disease / diagnostic imaging*
Scheuermann Disease / surgery

Supplementary concepts

Intervertebral disc disease