Occult intraspinal anomalies in congenital scoliosis

Thirty consecutive patients with congenital spinal deformity underwent magn etic resonance imaging (MRI) to determine the incidence of occult intraspin al anomaly. These congenital spinal deformities included 29 cases of congen ital scoliosis and one case of congenital kyphosis. Physical examination fi ndings and plain radiographs were reviewed in an attempt to correlate these findings with subsequent intraspinal pathology. Nine patients had intraspi nal 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 exam ination and plain radiographs. Two other patients had findings on plain rad iographs previously associated with high prevalence of occult intraspinal a nomalies; one patient with congenital kyphosis had a tethered cord, and one patient with a unilateral hemivertebrae associated with a contralateral ba r had a tethered cord. Two of nine patients with occult intraspinal anomali es 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 physic al examination findings suggestive of their subsequent MRI findings. Given the poor correlation between findings on physical examination, plain radiog raphs, and subsequent occult intraspinal anomalies on MRI, we believe that MRI is helpful in evaluating patients with congenital spinal anomalies.