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Thread: 8.9% of children with Scoliosis have a neural axis abnormality

  1. #1
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    8.9% of children with Scoliosis have a neural axis abnormality

    Long story short neural axis abnormalities may be a risk factor for Scoliosis but they don't tell doctors much about the type of curve or severity of the condition.

    Neural Axis Abnormalities in Patients With Adolescent Idiopathic Scoliosis: Is Routine Magnetic Resonance Imaging Indicated Irrespective of Curve Severity?

    OBJECTIVE:
    MRI-verified neural axis abnormality (NAA) has been described in adolescent idiopathic scoliosis (AIS) and several risk factors have been associated with the presence of NAA in AIS-patients. However, the clinical significance of these findings is not clear. The purpose of the present study was to determine the prevalence of NAAs in a large consecutive cohort of AIS patients and evaluate the clinical significance of previously proposed risk factors.

    METHODS:
    We prospectively included AIS patients referred to a tertiary facility for evaluation. Full-spine MRI scans were performed on all included patients irrespective of curve magnitude or proposed treatment modality. MRI scans were prospectively analyzed by a neuroradiologist and pathologic findings were confirmed by a second independent radiologist.

    RESULTS:
    Of 381 patients, NAA was observed in 34 (8.9%): 32 patients had a syrinx, one patient had an arachnoid cyst and one patient had a Chiari malformation; 4 patients were referred to neurosurgical evaluation but none received any neurosurgical treatment. There was no statistically significant difference observed between the NAA and no-NAA groups in terms of sex, major curve size, thoracic kyphosis, left thoracic curve, curve convexity, curve progression or level of pain (p > 0.05).

    CONCLUSION:
    In this prospective study to examine the risk factors for NAA in AIS patients, we found that previously proposed risk factors could not predict the MRI outcome. The finding of NAAs had no clinical implication and we do not support MRI scans as a routine diagnostic modality in all AIS patients.

  2. #2
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    Pam (Texasmarinemom) is the only member here I know of that had a shunt installed for a syrinx as a child. She mentioned it a few times back when she was active here on the forum years ago. She is sharp one on the subject of scoliosis.

    Below they mention that syrinx drainage is controversial.....although some support it. (Under the age of 10)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078323/

    I had many MRI's done through the years....This most likely due to my increased rotation. I have also had them stop during the process, (They would re-shoot) on both MRI's and CT's due to the extreme rotation I had. Shooting a spring and getting a clear image is not easy. (This was many years ago, I am hoping the machines and programs have improved since then)

    From glancing through all these related studies, it looks like MRI is warranted for kids under age 10, and spines with a lot of vertebral rotation.

    I don't see why MRI charges have to be so high. This technology has been around for quite a while, charges should come down (like x-rays) and financials should not be a hindrance for doctors. I wouldn't want to be in the group that doesn't warrant MRI and have them miss something. Diagnostics were invented for a reason, not using MRI as a diagnostic tool doesn't make any sense.

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  3. #3
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    Quote Originally Posted by titaniumed View Post
    Below they mention that syrinx drainage is controversial.....although some support it. (Under the age of 10)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078323/

    From glancing through all these related studies, it looks like MRI is warranted for kids under age 10, and spines with a lot of vertebral rotation.
    Are you sure that's not backwards? Maybe different studies produced different results.

    This is from your link.

    Scoliosis with syringomyelia has been characterized by 44–50% incidence of left thoracic curves [7, 9, 15, 22], juvenile or skeletally immature patients [16], rapid curve progression [3, 18], less rotation than would otherwise be expected, and frequent association with headaches due to Chiari malformation.
    I should note Scott always had a lot of rotation and he does have a neural axis abnormality.

    My wife just looked at his diagnosis and he has Hydromyelia. His syrinx is 2.9mm between C5 and C6.

    Lucky for him most cases of Hydromyelia don't get worse over time.

    As such, people with slit-like syrinxes were shown to not get any worse over a long period of time, and not require surgery.
    Last edited by Dingo; 01-19-2019 at 06:39 PM.

  4. #4
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    It was from this study. Forgot to mention increased kyphosis

    https://www.ncbi.nlm.nih.gov/pubmed/20802396

    CONCLUSION:
    Of preoperative presumed AIS patients with right thoracic curves who underwent MRI evaluation of the neural axis, 6.8% were found to have neural axis abnormalities, with those having increased rotation and/or increased kyphosis at higher risk. Surgeons should use this information when deciding whether a preoperative MRI is indicated in those with right thoracic AIS curve patterns.

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
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    Only One-Of-Two was imaged. It is my understanding that she was imaged because of the rapid progression to look for a neural issue. It could be that another reason was because she was highly rotated.

    Two-Of-Two was not highly rotated and her curve did not move as quickly at first though it is move almost as fast at the end. She was never imaged. It could be that in identical twins, it may be sufficient to rule out neuro issues in one of them. I have no idea.

    There were a few incidental findings on the imaging which we had to chase down which were nothing. The imaging is really a double-edged sword with these incidental findings... more things to worry about that probably mean nothing.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Quote Originally Posted by Pooka1 View Post
    The imaging is really a double-edged sword with these incidental findings... more things to worry about that probably mean nothing.
    If they find Syringomyelia or Chiari that can be serious. But with the incidental stuff it's hard to know if it means anything.

    Scott's Hydromyelia is minor and it may (or may not) have had anything to do with his Scoliosis. I tend to think it's an indication that something didn't "go right" in the womb because it's probably a birth defect. Whatever didn't "go right" is probably what caused his Scoliosis which showed up before age 4.

  7. #7
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    The incidental findings I am talking about were not associated with the spine but were found in other areas.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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