Abstract
PurposeCongenital malformations of the bony vertebral column are often accompanied by spinal cord anomalies; these observations have been reinforced with the use of magnetic resonance imaging (MRI). We hypothesized that the incidence of cord anomalies will increase as the number and complexity of bony vertebral abnormalities increases.MethodsAll patients aged ≤13 years (n = 75) presenting to the pediatric spine clinic from 2003−2013 with congenital bony spinal deformity and both radiographs and MRI were analyzed retrospectively for bone and neural pathology. Chi-squared analysis was used to compare groups for categorical dependent variables. Independent t tests were used for continuous dependent variables. Significance was set at p < 0.05.ResultsFifty-five percent of congenital spine deformity patients (n = 41) had associated spinal cord anomalies on MRI. Complex bony abnormalities had a higher incidence of cord anomalies than simple abnormalities (67, 37 %; p = 0.011). Mixed deformities of segmentation and formation had a higher incidence of cord anomalies (73 %) than failures of formation (50 %) or segmentation (45 %) alone (p = 0.065). Deformities in the sacrococcygeal area had the highest rate of spinal cord anomalies (13 of 15 patients, 87 %). In 35 cases (47 %), MRI revealed additional bony anomalies that were not seen on the radiographs.ConclusionsAs the number of bony malformations increased, we found a higher incidence of cord anomalies. Clinicians should have increased suspicion of spinal cord pathology in the presence of mixed failures of segmentation and formation.
Highlights
The vertebral column and spinal cord are closely related from an anatomical and developmental perspective
Purpose Congenital malformations of the bony vertebral column are often accompanied by spinal cord anomalies; these observations have been reinforced with the use of magnetic resonance imaging (MRI)
Radiographs were evaluated for bony vertebral abnormalities, and MRI images were reviewed for anomalies of the spinal cord and meninges and for bony anomalies missed on plain radiographs
Summary
The vertebral column and spinal cord are closely related from an anatomical and developmental perspective. Congenital malformations of the bony structure of the vertebral column, those associated with scoliosis and kyphosis, are often accompanied by abnormalities of the spinal cord [1,2,3,4]. Defects of formation include hemivertebrae, anteriorly wedged, and butterfly vertebrae, while defects of segmentation include unsegmented bars and block vertebrae [2,3,4]. This morphologic classification has prognostic value in that spinal column deformity associated with unilateral segmentation defects (bars), contiguous ipsilateral hemivertebra, or bars opposite hemivertebra are more likely to progress. The three dimensional nature of spinal deformity makes the distinction between scoliosis and kyphosis arbitrary and often both sagittal and coronal deformity exists [1, 2]
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