title: MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?
abstract: Patients with preoperative spine magnetic resonance imaging (MRI) studies from a prospective multicenter study of operative adolescent Scheuermann kyphosis (SK).
  
  
  
  To investigate the usefulness of MRI screening in operative planning for SK surgeries.
  
  
  
  Neural axis abnormalities in operative SK have not been previously studied with MRI screening, despite its use.
  
  
  
  One orthopedic surgeon and two radiologists evaluated all images retrospectively. Radiographs were evaluated for kyphosis apex and magnitude. MRIs were evaluated for spinal cord abnormalities, epidural lipomatosis, location and number of vertebral wedging, Schmorl nodes and posterior disc herniations, frequency of spondylolysis, etc. The relationship of these pathologies to the kyphosis apex was explored. This group was compared to a surgical SK group without preoperative MRIs.
  
  
  
  Eighty-six patients with MRIs, mean age 16.3 years, 64% male, and a mean preoperative kyphosis of 75.9° were evaluated. There were 17 spinal cord abnormalities. Low-lying conus was found in 2 patients, and syrinx in 15 (no Chiari malformations). Epidural lipomatosis was found in 49 patients, average of 5.7 levels. Anterior vertebral wedging occurred in all (mean 4.7 levels). Posterior disc herniations averaged 5.2 levels/patient and 1.8 levels caudad to the apex. Spondylolysis was reported in 8.1%. Four cases (4.7%) had the operative plan changed as a result of the preoperative MRI: two due to neural compression, one due to disc herniation and one due to a spinal cord draped over the apex. Thirty-one patients did not receive an MRI; there were no significant differences between the two groups. The rate of postoperative neurologic change was 3.5% in the MRI group and 3.2% in the no-MRI group.
  
  
  
  Based on 4.7% of cases requiring a change in the operative plan as a result of preoperative MRI, the authors recommend considering performing screening MRI in operative SK patients.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 820 Second Ave, New York, NY 10017, USA. Electronic address: blonner@scoliosisassociates.com.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: School of Medicine, New York University, New York, NY 10003, USA.
authors.forename: Courtney S
authors.initials: CS
authors.lastname: Toombs
authors.affiliation: Department of Radiology, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mechlin
authors.affiliation: Department of Radiology, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Ciavarra
authors.affiliation: Department of Orthopedics, Nemours/Alfred I duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA.
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Shriner's Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.affiliation: Division of Pediatric Orthopaedics, All Children's Hospital at Johns Hopkins, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Sponseller
authors.affiliation: Division of Pediatric Spinal Surgery, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA.
authors.forename: Harry L
authors.initials: HL
authors.lastname: Shufflebarger
authors.affiliation: Shriner's Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
authors.forename: Burt
authors.initials: B
authors.lastname: Yaszay
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000209:etiology; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000209:etiology; D008068:Lipomatosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012544:Scheuermann Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: MRI; Scheuermann kyphosis; Spinal fusion