title: The prevalence of abnormal preoperative neurological examination in Scheuermann kyphosis: correlation with X-ray, magnetic resonance imaging, and surgical outcome.
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment.
  
  
  BACKGROUND
  There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis.
  
  
  METHODS
  Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients' charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination.
  
  
  RESULTS
  There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0° (AbN) and 72.5° (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI.
  
  
  CONCLUSIONS
  The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues.
  
  
  METHODS
  4.
authors.affiliation: *Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY; and †Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Guangxun
authors.initials: G
authors.lastname: Hu
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.forename: Ian G
authors.initials: IG
authors.lastname: Dorward
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kang
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.forename: Linda A
authors.initials: LA
authors.lastname: Koester
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity; D009460:Neurologic Examination; D019637:Orthopedic Procedures; D011237:Predictive Value of Tests; D015995:Prevalence; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012544:Scheuermann Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012677:Sensation; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult