Treatment planning in severe scoliosis: the role of MRI

The use of magnetic resonance imaging (MRI) in the preoperative investigati on of children with idiopathic scoliosis is controversial. Syringomyelia an d other intraspinal lesions may be risk factors for neurological injury dur ing surgical correction. Our purpose was to investigate whether pathology o f the neuraxis is associated with scoliosis and to detect lesions which may threaten neurological sequelae during distraction and instrumented correct ion. We obtained T1- and T2-weighted images of 40 children (28 girls, 12 bo ys), mean age 12.7 years with severe idiopathic scoliosis (Cobb angle 50-70 degrees) obtained in coronal, sagittal and axial planes from the posterior cranial fossa to the sacrum, and these were assessed by two neuroradiologi sts and an orthopaedic surgeon prior to further treatment planning. Abnorma lities of the neuraxis were found in 24 patients (60 %); five (12 %) had tw o or more lesions. No abnormalities of the neuraxis were found in 16 patien ts (40 %). There were 15 patients (38 %) with intraspinal abnormalities who deteriorated clinically and nine (22 %) who showed no clinical changes. We transferred 16 patients (40 %) from the orthopaedic to the neurosurgical d epartment for further assessment. Our results suggest that one should inves tigate the neuraxis with MRI before contemplating orthopaedic surgical corr ection of severe idiopathic scoliosis, because the findings may lead to a c hange of procedure.