16. Incidence of intraspinal anomalies in congenital and other subtypes of idiopathic scoliosis: a radiological insight based on 320 scoliosis patients

BACKGROUND CONTEXT Intraspinal anomalies like syringomyelia, split cord malformations and low-lying tethered cord may lead to neurologic deficits if not detected and addressed before corrective surgery for scoliosis. Hence it is necessary to recognize 'patient at risk' and other factors contributing to such intraspinal abnormalities so they can be detected and treated before the corrected surgery for scoliosis. PURPOSE Intraspinal anomalies are quite common in pediatric scoliosis patient and all deformity patients need to undergo radiological-MRI investigations before surgical deformity correction. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE A total of 320 patients. OUTCOME MEASURES Intraspinal anomalies seen on neural axis MRI. METHODS A cross sectional observational study was done from the retrospective data of 320 patients for surgical deformity correction between 2014 and 2020. Neural axis MRI from brain stem to sacrum to screen the intraspinal abnormities were done. Under group A, a total of 185 patients including 67 males (36.2 %) and 118 females (63.8 %) were studied and a total of 107 patients including 21 males (19.63%) and 86 females (80.37%) were studied under group B. Data were compared using chi square test for categorical values and unpaired T test for numerical values. RESULTS Intraspinal anomalies were detected in 33.5% patients under group A. The most common anomaly reported was tethered cord (n=42, 22.7%%) followed by diastematomyelia (n=23, 12.4%%), syringomyelia/syringohydromyelia (n=7, 3.8%), meningocele (n=5, 2.7%). Under group B, intraspinal anomalies were detected in 8.4% (n=9) patients. Tethered cord was the most common intraspinal anomaly seen in 4 patients. There was no significant difference in the incidence of intraspinal anomalies between right sided curves and left sided curves under both groups. There was no correlation between the magnitude of scoliosis and the presence of intraspinal anomalies. CONCLUSIONS This highlights the importance of a preoperative MRI in all patients with congenital scoliosis before corrective surgery. We would also suggest a mandatory preoperative MRI in patients with adolescent idiopathic scoliosis with a thoracolumbar curve. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Intraspinal anomalies like syringomyelia, split cord malformations and low-lying tethered cord may lead to neurologic deficits if not detected and addressed before corrective surgery for scoliosis. Hence it is necessary to recognize 'patient at risk' and other factors contributing to such intraspinal abnormalities so they can be detected and treated before the corrected surgery for scoliosis. Intraspinal anomalies are quite common in pediatric scoliosis patient and all deformity patients need to undergo radiological-MRI investigations before surgical deformity correction. Retrospective observational study. A total of 320 patients. Intraspinal anomalies seen on neural axis MRI. A cross sectional observational study was done from the retrospective data of 320 patients for surgical deformity correction between 2014 and 2020. Neural axis MRI from brain stem to sacrum to screen the intraspinal abnormities were done. Under group A, a total of 185 patients including 67 males (36.2 %) and 118 females (63.8 %) were studied and a total of 107 patients including 21 males (19.63%) and 86 females (80.37%) were studied under group B. Data were compared using chi square test for categorical values and unpaired T test for numerical values. Intraspinal anomalies were detected in 33.5% patients under group A. The most common anomaly reported was tethered cord (n=42, 22.7%%) followed by diastematomyelia (n=23, 12.4%%), syringomyelia/syringohydromyelia (n=7, 3.8%), meningocele (n=5, 2.7%). Under group B, intraspinal anomalies were detected in 8.4% (n=9) patients. Tethered cord was the most common intraspinal anomaly seen in 4 patients. There was no significant difference in the incidence of intraspinal anomalies between right sided curves and left sided curves under both groups. There was no correlation between the magnitude of scoliosis and the presence of intraspinal anomalies. This highlights the importance of a preoperative MRI in all patients with congenital scoliosis before corrective surgery. We would also suggest a mandatory preoperative MRI in patients with adolescent idiopathic scoliosis with a thoracolumbar curve.