Most patients with scoliosis developing after 10 years old do not need routine magnetic resonance imaging (MRI) scanning before spine-straightening surgery, suggests a study in Spine. In young scoliosis patients without symptoms of neurological abnormalities, preoperative MRI scanning adds costs while detecting few abnormalities and adding little information for surgical planning, according to research led by Mohammad Diab, MD, University of California San Francisco.
The researchers analyzed data on 2,206 patients with adolescent idiopathic scoliosis, drawn from a larger study of scoliosis surgery in children. Adolescent idiopathic scoliosis is the most common type of scoliosis, generally developing after age 10. These children have no identifiable cause of their spinal curvature—idiopathic means “unknown cause.” The patients were 1,812 girls and 394 boys. The average age at scoliosis surgery was 14 years and 3 months.
Forty-two percent of the patients underwent MRI scanning before surgery. Preoperative MRI is sometimes recommended to check for accompanying conditions that may affect the surgical plan—especially neurological conditions causing damage to the spinal cord itself. None of the children in the study had any signs of neurological problems before surgery.
The MRI scans detected other abnormalities in about 10% of children screened, or about 4% overall. The most common abnormalities were congenital malformations (syringes and Chiari malformations) with the potential to cause spinal cord damage. Patients with these neurological abnormalities need neurosurgery, in addition to straightening of the spinal curve.
The study provides spinal surgeons with new guidance on using MRI for preoperative assessment of patients with adolescent idiopathic scoliosis. The results suggest that MRI is currently “over-requested”—it is performed in a relatively high number of patients, most of whom have no abnormality. In this situation, performing MRI not only adds unnecessary costs, but may potentially lead to increased risks, according to the authors of the study.
“The use of MRI must be scrutinized in the current climate of escalating health care expenditures,” the authors stated in the study.
Although the study may stir debate among surgeons, Diab and co-authors believe that most patients with adolescent idiopathic scoliosis—as long as they have no symptoms indicating neurological abnormalities—do not need MRI scanning before surgery.
“Our data question the routine use of MRI as a screening tool for adolescent idiopathic scoliosis,” the authors stated in a press release.