Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity - Is a magnetic resonance image screening necessary?

Study Design. A prospective and retrospective review of patients 10 years and younger with idiopathic scoliosis evaluated with a total spine magnetic resonance imaging (MRI) scan. Objectives. To determine the incidence of neural axis abnormalities in infantile and juvenile patients with idiopathic scoliosis without neurologic findings on history and examination, to determine the need for a screening MRI in this age group. Summary of Background Data. In previous studies, a 19.2% and 26% incidence of neural axis abnormalities were found in infantile and juvenile patients with "idiopathic" scoliosis, respectively, raising the question of routine MRI screening of the spinal canal in these patients. Methods. A prospective study included 34 consecutive patients newborn to 10 years of age treated between 1992 and 1996 at a spinal deformity clinic with idiopathic scoliosis >20 degrees without neurologic findings. In addition, a retrospective review of 64 patients age newborn to 10 years of age with idiopathic scoliosis was performed. All patients were evaluated by a total spine MRI protocol for examination of neural axis abnormalities. Results. The incidence of neural axis abnormalities in the prospective group of 34 patients was 17.6% (6 of 34); the incidence of neural axis abnormalities was 20.3% (13 of 64) in the retrospective group. Of 6 patients in the infantile age range, 3 (50%) had neural axis abnormalities. Conclusions. A total spine MRI is recommended at presentation in patients with juvenile onset idiopathic scoliosis (> 20 degrees) because of the high incidence of neural axis abnormalities. Further study appears warranted to establish the incidence of neural axis abnormalities in infantile idiopathic scoliosis to determine the need for total spine MRI screening in this age group.