Occult intraspinal anomalies in association with an isolated congenital hemivertebra

Abstract

Purpose of study: Previous studies have reported the high incidence of intraspinal anomalies in congenital scoliosis. However, various authors do not consider the presence of an isolated hemivertebra sufficient to warrant magnetic resonance imaging (MRI). To our knowledge, the incidence of intraspinal anomalies detected by MRI and the need for subsequent neurosurgical intervention comparing patients with a single hemivertebra versus patients with a complex pattern involving with hemivertebra at multiple levels or a hemivertebra coupled with a failure of segmentation is unknown.Methods used: A retrospective review over a10-year period (1988–1998) of physical examination findings and plain radiographs in patients presenting with congenital scoliosis and hemivertebra was conducted to correlate these results with the presence of intraspinal anomalies as detected by MRI and the need for subsequent neurosurgical intervention.of findings: A total of 116 patients with congenital scoliosis and a curve that included at least one hemivertebra were identified, 76 of whom presented after 1988 and had an MRI. These patients were the subject of this study and had a mean age at presentation of 59 months (range, 1 to 198 months) with mean follow-up of 7.1 years (range 1 to 17 years). Twenty-nine had an isolated hemivertebra, and 47 had a complex hemivertebral pattern. Six patients (21%) with isolated hemivertebra compared with 11 patients (23%) with a complex hemivertebral pattern had an MRI-detected intraspinal anomaly (p=.99). A positive history or physical examination finding was present in 41% of all patients and was of limited benefit in predicting the presence of intraspinal anomaly in either isolated hemivertebra (sensitivity, 67%; specificity, 43%) or complex hemivertebral patterns (sensitivity, 55%; specificity, 78%). Three patients with an isolated hemivertebra (10%) versus four patients with a complex hemivertebral pattern (9%) underwent neurosurgical intervention (p=.88). All seven patients who underwent neurosurgical intervention has an MRI-detected intraspinal anomaly, and five (71%, two complex and three isolated) had either an abnormal history or physical examination finding.Relationship between findings and existing knowledge: Isolated hemivertebra and complex hemivertebral patterns have similar incidences of MRI-detected intraspinal anomalies and subsequent need for neurosurgical intervention. Therefore, we recommend obtaining an MRI for all cases of congenital scoliosis, including isolated hemivertebra.Overall significance of findings: Isolated hemivertebra and complex hemivertebral patterns have similar incidences of MRI-detected intraspinal anomalies and subsequent need for neurosurgical intervention. Therefore, we recommend an MRI even for isolated hemivertebra.Disclosures: No disclosures.Conflict of interest: No conflicts.