Sequential MRI reveals vertebral body wedging significantly contributes to coronal plane deformity progression in adolescent idiopathic scoliosis during growth.

Abstract

Cross-sectional study. To provide a comprehensive, multi-stage investigation of vertebral body (VB) and intervertebral disc (IVD) coronal plane deformities for adolescent idiopathic scoliosis (AIS) patients with a main thoracic curve type, using a series of sequential magnetic resonance images (MRIs). Despite numerous investigations of AIS deformity at the spinal segmental level, there is little consensus as to the major contributor to the lateral curvature of a scoliotic spine. Moreover, scoliotic deformity is often described along a continuum of progression, with few studies having characterised the change in segmental deformity for AIS patients whose deformity progresses clinically over time. 30 female AIS patients with primary thoracic curves were included between 2012 and 2016. Three sequential MRIs were captured for each patient. Datasets were reformatted to produce true coronal plane images of the thoracic spine (T4-L1). Overall curve morphology, coronal plane IVD and VB segmental deformity and rates of growth were analysed. Right-side asymmetry was greater in IVDs (18.5 ± 23.9%) when compared to VBs (8.3 ± 9.2%) (P < 0.05) by third scans. Despite this, 77% of patients demonstrated the majority (> 50%) of their coronal curvature was attributed to VB wedging when measured across all three scans. Regardless of progression status, scan number, or region, the sum of the VB wedging angle was greater than the sum of the IVD wedging angle (all P ≤ 0.05). There was no correlation between the rates of major curve angle progression and standing height increase, VB height growth, or IVD height growth (P > 0.05). VB wedging contributed more to the lateral deformity observed in primary thoracic subtypes of AIS patients than IVD wedging. While IVDs demonstrated the greatest asymmetric deformity, their relatively smaller height resulted in a smaller proportional change in lateral curve angle compared to the VBs. IV.