Reference
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1. Musson RE, Warren DJ, Bickle I, Connolly DJ, Griffiths PD. Imaging in childhood scoliosis: a pictorial review. Postgrad Med J. 2010;86(1017):419-427. Review/Other-Dx N/A To examine the different imaging techniques currently used in the evaluation of scoliosis and provide a pictorial summary of the more common causes and associations. No results stated in abstract. 4
2. Qiu Y, Zhu F, Wang B, et al. Clinical etiological classification of scoliosis: report of 1289 cases. Orthop Surg. 2009;1(1):12-16. Review/Other-Dx 1289 patients To analyze data collected at the authors' center according to the current etiological spectrum and classification of scoliosis. The prevalence of non-idiopathic scoliosis was 25.3% in the whole series, but it increased to 34% in the surgical group aged from 9 to 28 years. Thirty-nine percent of patients with congenital scoliosis presented at least one developmental spinal cord malformation. 4
3. Khanna G. Role of imaging in scoliosis. Pediatr Radiol. 2009;39 Suppl 2:S247-251. Review/Other-Dx N/A Role of imaging in scoliosis. No abstract available. 4
4. Davids JR, Chamberlin E, Blackhurst DW. Indications for magnetic resonance imaging in presumed adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2004;86-A(10):2187-2195. Observational-Dx 1280 children To establish which of these indicators (pain, as determined by the clinical history; abnormal neurological findings, as determined by the physical examination; and atypical curve patterns, as determined radiographically)  best predicts the finding of clinically relevant abnormality of the central nervous system in patients with presumed adolescent idiopathic scoliosis. Magnetic resonance imaging was ordered for 274 (21%) of the 1280 children who were evaluated. Abnormal findings were seen in twenty-seven (10%) of the 274 patients who underwent imaging, or 2% of the entire cohort. The most valuable single indicator of an abnormal finding on magnetic resonance imaging was absence of thoracic apical segment lordosis: eight of thirty-nine patients with that indicator had an abnormal finding on magnetic resonance imaging. The optimal diagnostic yield for a single category of indicators occurred when an atypical curve pattern was the only indicator: six of fifty-eight patients in whom this was the case had an abnormal finding on magnetic resonance imaging. None of the twenty children in whom pain was the only indicator category had an abnormal imaging study. The optimal diagnostic yield occurred when both an atypical curve pattern and neurological indicators were present: thirteen (25%) of fifty-three patients in whom this was the case had an abnormal finding on magnetic resonance imaging. Thirteen of the twenty-seven patients received surgical treatment for the abnormality of the central nervous system revealed by the imaging. 3
5. Nakahara D, Yonezawa I, Kobanawa K, et al. Magnetic resonance imaging evaluation of patients with idiopathic scoliosis: a prospective study of four hundred seventy-two outpatients. Spine (Phila Pa 1976). 2011;36(7):E482-485. Review/Other-Dx 472 patients To determine the prevalence of neural axis abnormalities in outpatients with scoliosis and to analyze the characteristics of patients who had such abnormalities. The incidence of neural axis abnormalities on MRI was 3.8% (18 of 472 patients). Among the 18 patients, 6 had a Chiari I malformation alone, 10 had a Chiari I malformation combined with syringomyelia, and 2 had a syringomyelia without Chiari I malformation. Male gender, patients younger than 11 years old, and abnormal superficial abdominal reflexes were significantly associated with the detection of neural axis abnormalities on MRI. 4
6. Diab M, Landman Z, Lubicky J, Dormans J, Erickson M, Richards BS. Use and outcome of MRI in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2011;36(8):667-671. Observational-Dx 2206 children To report on the use and outcomes of preoperative magnetic resonance imaging (MRI) in a prospective cohort study of 2206 children undergoing posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. There were 1812 girls (80.8%) and 394 boys (17.5%). Mean age at operation was 14 years and 3 months. A total of 191 (8.6%) had juvenile idiopathic scoliosis (age </= 10 years). A total of 923 patients (41.8%) underwent spine MRI. Ninety-one abnormalities of the spine were detected (9.9% of the 923 screened), of which 39 (4.2%) were neural. There were 26 syringes (66.7% of neural abnormalities and 28.6% of all abnormalities), 12 Chiari malformations (30.7% and 13.2%, respectively), and 1 tethered cord (2.6% and 1.1%, respectively). Fifty-three patients (5.7%) demonstrated abnormalities affecting "other" parts of the spine than the neural elements. Patients undergoing MRI more frequently had a thoracic hyperkyphosis (P < 0.001), had a diagnosis of juvenile idiopathic scoliosis (P < 0.001), had a Risser grade between 0 and 2 (P = 0.022), had a greater curve magnitude (P < 0.001), had three major curves (P < 0.001), were male (P = 0.004), and underwent a combined anterior-posterior surgical approach (P < 0.001). Thoracic hyperkyphosis and juvenile onset were associated with greater chance of neural lesion on MRI of the spine. Incidence of abnormal MRI did not differ significantly by direction of apex, Risser grade, curve magnitude or type, male sex, or body mass index. 3
7. Ozturk C, Karadereler S, Ornek I, Enercan M, Ganiyusufoglu K, Hamzaoglu A. The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis. Int Orthop. 2010;34(4):543-546. Review/Other-Dx 249 patients To demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. 4
8. Qiao J, Zhu Z, Zhu F, et al. Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis. Eur Spine J. 2013;22(2):360-366. Review/Other-Dx 446 patients To investigate the incidence of neural axis abnormalities in patients with presumed "idiopathic" thoracolumbar or lumbar scoliosis by magnetic resonance imaging (MRI) and try to determine which clinical and radiographic characteristics correlate with neural axis abnormalities on MRI in these patients. Neural axis abnormalities were detected in 35 (7.8 %) patients. For patients with neural axis abnormalities, a higher proportion of male gender and long thoracolumbar curves were presented. In these patients, the mean age was smaller and the mean Cobb angle of main curve was larger. Greater thoracic kyphosis (>/= 30 degrees ) was more frequently found in those with neural axis abnormalities. The incidences of thoracolumbar junction hyperkyphosis were similar between two groups (P > 0.05). There was no difference between two groups as to lumbar lordosis and coronal and sagittal balance. 4
9. Benli IT, Uzumcugil O, Aydin E, Ates B, Gurses L, Hekimoglu B. Magnetic resonance imaging abnormalities of neural axis in Lenke type 1 idiopathic scoliosis. Spine (Phila Pa 1976). 2006;31(16):1828-1833. Review/Other-Dx 104 patients To examine the frequency of neural axis abnormalities and the need for preoperative MRI in this group of patients. All 7 patients with a neural axis abnormality on MRI had an early onset disease, and 6 of them had back pain. Thus, age of onset and back pain seem to be predictive of these abnormalities. Frequency of MRI abnormalities was as high as 45% for patients with back pain in addition to a type IC curve. 4
10. Cardoso M, Keating RF. Neurosurgical management of spinal dysraphism and neurogenic scoliosis. Spine (Phila Pa 1976). 2009;34(17):1775-1782. Review/Other-Dx N/A To review diagnosis and treatment of neurogenic factors implicated in the development of progressive scoliosis. Timely recognition of these frequently progressive conditions may not only prevent irreversible neurologic compromise but may also help to ameliorate or stabilize concurrent scoliosis. Tethered cords are best treated by releasing the affected cord and offers the best opportunity to stabilize or improve the scoliosis. Syringomyelia, often associated with a Chiari malformation, is a well-known progenitor of scoliosis, and addressing the underlying cause with a Chiari decompression frequently leads to a reduction or resolution of the syrinx and may result in a concomitant improvement in scoliosis. 4
11. Belmont PJ, Jr., Kuklo TR, Taylor KF, Freedman BA, Prahinski JR, Kruse RW. Intraspinal anomalies associated with isolated congenital hemivertebra: the role of routine magnetic resonance imaging. J Bone Joint Surg Am. 2004;86-A(8):1704-1710. Observational-Dx 116 patients To study all patients with a hemivertebra, after eliminating patients with a myelomeningocele, to compare those who had a single hemivertebra with those who had a complex hemivertebral pattern. One hundred and sixteen patients with congenital scoliosis and a curve that included at least one hemivertebra were identified. Seventy-six of these patients had had magnetic resonance imaging and were included in the present study. The mean age of these patients at the time of presentation was 4.9 years, and the mean duration of follow-up was 7.7 years. Twenty-nine patients had an isolated hemivertebra, and forty-seven patients had a complex hemivertebral pattern. Eight (28%) of the twenty-nine patients with an isolated hemivertebra and ten (21%) of the forty-seven patients with a complex hemivertebral pattern had an intraspinal anomaly that was detected with magnetic resonance imaging. Overall, an abnormal finding on the history or physical examination demonstrated an accuracy of 71%, a sensitivity of 56%, a specificity of 76%, a positive predictive value of 42%, and a negative predictive value of 85% for the diagnosis of an intraspinal anomaly. Three patients with an isolated hemivertebra and five patients with a complex hemivertebral pattern underwent neurosurgical intervention. All eight patients who underwent neurosurgical intervention had had detection of an intraspinal anomaly with magnetic resonance imaging, whereas only four of these patients (two of whom had an isolated hemivertebra and two of whom had a complex hemivertebral pattern) had had an abnormal finding on either the history or the physical examination. 3
12. Knott P, Pappo E, Cameron M, et al. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. Scoliosis. 2014;9:4. Review/Other-Dx N/A To review the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Using the Delphi technique, SOSORT members developed consensus statements that describe how often radiographs should be taken in each of the pediatric and adolescent sub-populations. 4
13. American College of Radiology. ACR-SPR-SSR Practice Parameter for the Performance of Radiography for Scoliosis in Children. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Scoliosis.pdf. Review/Other-Dx N/A To provide an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. No abstract available. 4
14. Kluba T, Schafer J, Hahnfeldt T, Niemeyer T. Prospective randomized comparison of radiation exposure from full spine radiographs obtained in three different techniques. Eur Spine J. 2006;15(6):752-756. Observational-Dx 150 patients To compare two different digital X-ray techniques with conventional standing full spine films. To evaluate dose area product, image quality and inter-observer error of Cobb-angle measurement in patients with scoliosis and kyphoscoliosis. The mean dose area product was 97.0 cGy cm(2) (37.0-380.0 cGy cm(2)) for conventional films, 31.5 cGy cm(2) (6.0-66.0 cGy cm(2)) for CR imaging and 5.0 cGy cm(2) (1.0-29.0 cGy cm(2)) for digital fluoroscopy. The differences of Cobb-angle measurements were not significantly different for the three methods. Differences in the count of pedicles and endplates between the investigators were significantly lower for the conventional film as an indicator for the best detail presentation. 2
15. Deschenes S, Charron G, Beaudoin G, et al. Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine (Phila Pa 1976). 2010;35(9):989-994. Observational-Dx 50 patients To validate the assertion that slot-scanner show the potential to produce image quality comparable to CR systems using less radiation by comparing a new slot-scanner to a CR system through a wide-ranging evaluation of dose and image quality for scoliosis examinations. Average skin dose was reduced from 6 to 9 times in the thoracoabdominal region when using the slot-scanner instead of CR. Moreover, image quality was significantly better with EOS for all structures in the frontal view (P < 0.006) and lateral view (P < 0.04), except for lumbar spinous processes, better seen on the CR (P < 0.003). 1
16. Sakai Y, Matsuyama Y, Nakamura H, et al. Segmental pedicle screwing for idiopathic scoliosis using computer-assisted surgery. J Spinal Disord Tech. 2008;21(3):181-186. Observational-Tx 40 patients To evaluate the accuracy of computer-assisted surgery for idiopathic scoliosis. Pedicle violation was observed in 28.0% of the control group and 11.4% of the navigation group, with significant differences. No screw misplacements at the registered levels were seen, and the longer the distance between the registered level and level of screw insertion, the higher the rate of pedicle violation. No intraoperative complications caused by pedicle perforation occurred. 3
17. Ughwanogho E, Patel NM, Baldwin KD, Sampson NR, Flynn JM. Computed tomography-guided navigation of thoracic pedicle screws for adolescent idiopathic scoliosis results in more accurate placement and less screw removal. Spine (Phila Pa 1976). 2012;37(8):E473-478. Observational-Dx 42 patients To compare the accuracy and safety of thoracic pedicle screw placement and frequency of intraoperative removal using computed tomography-guided navigation (CTGN) versus conventional freehand technique in adolescent idiopathic scoliosis (AIS). In 42 patients, 485 screws were evaluable with a visible pedicle and screw (300 navigated and 185 non-navigated). Screws were classified as follows: optimal screws, 74% CTGN versus 42% non-navigated; acceptable screws, 23% CTGN versus 49% non-navigated; and potentially unsafe, 3% CTGN versus 9% non-navigated (P < 0.001). A potentially unsafe screw was 3.8 times less likely to be inserted with navigation (P = 0.003). The odds of a significant medial breach were 7.6 times higher without navigation (P < 0.001). A screw was 8.3 times more likely to be removed intraoperatively in the non-navigated cohort (P = 0.003). 3
18. Abul-Kasim K, Overgaard A, Maly P, Ohlin A, Gunnarsson M, Sundgren PC. Low-dose helical computed tomography (CT) in the perioperative workup of adolescent idiopathic scoliosis. Eur Radiol. 2009;19(3):610-618. Observational-Dx 240 CTs To estimate the radiation dose in patients examined with low dose spine CT and to compare it with that received by patients undergoing standard CT for trauma of the same region, as well as to evaluate the impact of dose reduction on image quality. Radiation doses in 113 consecutive low dose spine CTs were compared with those in 127 CTs for trauma. The inter- and intraobserver agreement in measurements of pedicular width, and vertebral rotation, measurements of signal-to-noise ratio and assessment of hardware status were the indicators in the evaluation of image quality. The effective dose of the low dose spine CT (0.37 mSv) was 20 times lower than that of a standard CT for trauma (13.09 mSv). This dose reduction conveyed no impact on image quality. 3
19. Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(3):364-368. Review/Other-Dx 2442 patients To determine the prevalence of back pain and its association with an underlying pathological condition. Five hundred and sixty (23 per cent) of the 2442 patients had back pain at the time of presentation, and an additional 210 (9 per cent) had back pain during the period of observation. There was a significant association between back pain and an age of more than fifteen years, skeletal maturity (a Risser sign of 2 or more), postmenarchal status, and a history of injury. There was no association with gender, family history of scoliosis, limb-length discrepancy, magnitude or type of curve, or spinal alignment. At the latest follow-up evaluation, 324 (58 per cent) of the 560 patients who had had back pain at presentation had no additional symptoms. Forty-eight (9 per cent) of the 560 patients who had back pain had an underlying pathological condition: twenty-nine patients had spondylolysis or spondylolisthesis, nine had Scheurmann kyphosis, five had a syrinx, two had a herniated disc, one had hydromyelia, one had a tethered cord, and one had an intraspinal tumor. A painful left thoracic curve or an abnormal neurological finding was most predictive of an underlying pathological condition, although only eight of the thirty-three patients who had such findings were found to have such a condition. 4
20. Davies A, Saifuddin A. Imaging of painful scoliosis. Skeletal Radiol. 2009;38(3):207-223. Review/Other-Dx N/A To illustrate the causes of a painful scoliosis in children, adolescents and adults No results stated in abstract. 4
21. Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509, vi. Review/Other-Dx N/A To review the general surgical principles that need to be followed to treat patients with congenital spine deformities safely. No results stated in abstract. 4
22. Kim H, Kim HS, Moon ES, et al. Scoliosis imaging: what radiologists should know. Radiographics. 2010;30(7):1823-1842. Review/Other-Dx N/A To (a) describe the biomechanics, classification, nomenclature, and measurement of scoliosis; (b) provide specific information about the current uses of radiography, CT, and MR imaging to diagnose idiopathic scoliosis and guide its management; (c) help radiologists identify appropriate imaging modalities for evaluating idiopathic and secondary scoliosis; and, finally, (d) explain the basic principles of scoliosis management. No results stated in abstract. 4
23. Kose N, Campbell RM. Congenital scoliosis. Med Sci Monit. 2004;10(5):RA104-110. Review/Other-Dx N/A To discuss congenital scoliosis. No results stated in abstract. 4
24. Shen J, Wang Z, Liu J, Xue X, Qiu G. Abnormalities associated with congenital scoliosis: a retrospective study of 226 Chinese surgical cases. Spine (Phila Pa 1976). 2013;38(10):814-818. Review/Other-Dx 226 patients To identify the incidence of intraspinal abnormalities and other organ defects in surgical patients with congenital scoliosis in Chinese population. Intraspinal abnormalities were found in 99 (43%) patients. Diastematomyelia was identified to be the most common intraspinal pathological anomaly, which was different from the previous reports. The incidence of intraspinal anomaly in patients with failures of segmentation and mixed defects were significantly higher than those with failures of formation. Patients with thoracic hemivertebrae were found to have a higher incidence of intraspinal abnormalities than patients with lumbar hemivertebrae. Patients with intraspinal abnormality had a higher incidence of positive clinical findings than those with normal magnetic resonance imaging. However, the difference between the 2 groups was not statistically significant. Other organic defects were found in 91(40%) patients. Cardiac defects were detected in 18%, urogenital anomalies in 12%, and gastrointestinal anomalies in 5% of the patients in this study. 4
25. Kawakami N, Tsuji T, Imagama S, Lenke LG, Puno RM, Kuklo TR. Classification of congenital scoliosis and kyphosis: a new approach to the three-dimensional classification for progressive vertebral anomalies requiring operative treatment. Spine (Phila Pa 1976). 2009;34(17):1756-1765. Review/Other-Dx 150 patients To clearly illustrate the limitations of two-dimensional classification, to summarize the clinical significance of 3D analysis of congenital vertebral anomalies, and to propose a new 3D classification of congenital vertebral anomalies. The images of plain radiograph cannot demonstrate the spatial relationship of each structure of the vertebrae. Three-dimensional findings in congenital-deformed vertebrae included several types of laminae and clearer definitions of each type of anomalous vertebrae. By developing an algorithm for the evaluation of congenital spinal deformity, congenital spinal deformity could be mainly classified into 4 types of congenital vertebral abnormalities: Type 1: solitary simple, Type 2: multiple simple, Type 3: complex, Type 4: segmentation failure. 4
26. Wu ZX, Huang LY, Sang HX, et al. Accuracy and safety assessment of pedicle screw placement using the rapid prototyping technique in severe congenital scoliosis. J Spinal Disord Tech. 2011;24(7):444-450. Observational-Tx 62 patients To compare the accuracy and safety of pedicle screw placement in congenital scoliosis using the RP technique versus the conventional fluoroscopy. Seventy of 677 inserted screws were found to be misplaced, showing an overall accuracy of 89.7% (90.8% in the thoracic spine and 87.4% in the lumbar spine). In the C-arm group, 86.1% (167 of 194) and 82.0% (82 of 100) of screws were accurately placed in the thoracic and lumbar spine, respectively. While in the RP group, the respective screw placement accuracies were 94.4% (238 of 252) and 91.6% (120 of 131). In the C-arm and the RP groups, 94.8% (279 of 294) and 97.9% (375 of 383) of the screws were within the safety zone, respectively. Compared with the fluoroscopy method, the RP-assisted technique showed a shorter operation time and higher scoliosis correction rate. No neurovascular-related complication was observed with this technique during the study. 2
27. Liu W, Zheng D, Cui S, et al. Characteristics of osseous septum of split cord malformation in patients presenting with scoliosis: a retrospective study of 48 cases. Pediatr Neurosurg. 2009;45(5):350-353. Review/Other-Dx 48 patients To delineate the configuration and nature of the osseous septa and to discuss the correlation between scoliosis and split cord malformation (SCM). The figuration, component, location and nature of osseous septa are described. 47 of the 48 SCMs (98%) were type I. Only 1 case was type II. 43 patients (90%) had 1 osseous septum. The other 5 patients (10%) had 2 osseous septa at different levels. 41 septa (78%) were mainly made of cortical bone, another 6 septa (11%) were mainly made of cancellous bone, while the other 6 (11%) were bone together with soft tissues. The prominent central blood vessels were found in 19 cases (36%). 10 osseous septa (19%) were derived from neural arches. 15 osseous septa (28%) were from both vertebral bodies and neural arches. 4
28. Koc T, Lam KS, Webb JK. Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study. Eur Spine J. 2013;22(6):1250-1254. Review/Other-Dx 72 patients To determine the rates of neural axis abnormalities in early onset idiopathic scoliosis patients in a British population. The mean age at diagnosis was 3.6 years and the mean Cobb angle was 47 degrees with a near equal distribution of left (32) and right (36) sided curves. Eight (11.1 %) neural axis abnormalities consisting of two syrinxes, one Arnold-chiari Type I malformation and five combined (Arnold-chiari malformation Type I and syrinx) anomalies were identified. 4
29. Malfair D, Flemming AK, Dvorak MF, et al. Radiographic evaluation of scoliosis: self-assessment module. AJR Am J Roentgenol. 2010;194(3 Suppl):S23-25. Review/Other-Dx N/A To provide an educational objectives for a self-assessment module that allows participants to exercise, self-assess, and improve his or her understanding of evaluation of scoliosis using radiography. No results stated in abstract. 4
30. Pahys JM, Samdani AF, Betz RR. Intraspinal anomalies in infantile idiopathic scoliosis: prevalence and role of magnetic resonance imaging. Spine (Phila Pa 1976). 2009;34(12):E434-438. Review/Other-Dx 54 patients To identify the prevalence of intraspinal anomalies in patients with presumed IIS at a single, large volume institution and further define the role for a screening MRI. MRI revealed a neural axis abnormality in 7 (13%) of 54 patients who underwent an MRI. In this subset of 7 patients, 5 (71.4%) required neurosurgical intervention. Tethered cord requiring surgical release was identified in 3 patients, Chiari malformation requiring surgical decompression was found in 2 patients, and a small nonoperative syrinx was found in 2 patients. 4
31. Trobisch P, Suess O, Schwab F. Idiopathic scoliosis. Dtsch Arztebl Int. 2010;107(49):875-883; quiz 884. Review/Other-Dx N/A To discuss idiopathic scoliosis. Scoliosis in children of school age and above primarily occurs in girls. Its prevalence is 1% to 2% among adolescents, but more than 50% among persons over age 60. The therapeutic goal in children is to prevent progression. In children, scoliosis of 20 degrees or more should be treated with a brace, and scoliosis of 45 degrees or more with surgery. The treatment of adults with scoliosis is determined on an individual basis, with physiotherapy and braces playing a relatively minor role. Adults (even elderly adults) who have scoliosis and sagittal imbalance may be best served by surgical treatment. 4
32. Donaldson S, Stephens D, Howard A, Alman B, Narayanan U, Wright JG. Surgical decision making in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32(14):1526-1532. Observational-Dx 4 pediatric spine surgeons To assess the reliability of surgeons' decision-making in adolescent idiopathic scoliosis (AIS) based on patient photographs and clinical and radiographic data. Surgeons' concordance in recommending patients for surgery and if they thought it would improve their appearance varied widely with kappa scores ranging from poor (0.34) to good (0.76). Recommendations for surgery were more consistent with the addition of radiographs but were not influenced by patients' body image perceptions. Surgeons' recommendations for surgery were also inconsistent with treatment actually received with overall kappa scores ranging from poor (0.32) to good (0.73). 2
33. Chen ZQ, Wang CF, Bai YS, et al. Using precisely controlled bidirectional orthopedic forces to assess flexibility in adolescent idiopathic scoliosis: comparisons between push-traction film, supine side bending, suspension, and fulcrum bending film. Spine (Phila Pa 1976). 2011;36(20):1679-1684. Observational-Dx 31 patients To validate the effectiveness of push-traction film (PTF) in assessment of curve flexibility in adolescent idiopathic scoliosis. In main thoracic (MT) group, correction rate (CR) of PTF was significantly higher than that of side bending (P = 0.010) and suspension (P = 0.000) but not significantly different from that of fulcrum bending (P = 0.335). In TL/L group, CR of PTF was significantly higher than that of suspension (P = 0.000), but not significantly different from that of side bending (P = 0.681) and fulcrum bending (P = 0.382). There was no significant difference between CR of PTF and postoperation in both MT (P = 0.122) and TL/L (P = 0.068) groups. Correlation and linear regression analyses showed that PTF provided the highest correlation of the four methods, with the postoperative angle in both MT (r = 0.957) and MT/L group (r = 0.779). 3
34. Davis BJ, Gadgil A, Trivedi J, Ahmed el NB. Traction radiography performed under general anesthetic: a new technique for assessing idiopathic scoliosis curves. Spine (Phila Pa 1976). 2004;29(21):2466-2470. Observational-Dx 24 patients To compare curve flexibility measured using supine bending radiography and traction radiography; to examine the correlation of each technique with postoperative correction; and to determine the influence of each technique on the decision to perform concomitant anterior release surgery with posterior instrumentation. Traction radiography demonstrated significantly greater curve flexibility than supine bending radiographs (P < 0.001). Eleven of 13 patients planned for anterior release surgery and posterior instrumentation avoided anterior release after review of the traction radiography. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.13). 3
35. Li J, Hwang S, Wang F, et al. An innovative fulcrum-bending radiographical technique to assess curve flexibility in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2013;38(24):E1527-1532. Observational-Dx 17 patients To introduce a redesigned fulcrum-bending radiographical (FBR) method, and to validate the effectiveness of this method in assessing patients with (AIS). Preoperatively, the mean Cobb angle was 47.5 degrees +/- 8.8 degrees on the posterior-anterior radiographs, 14.3 degrees +/- 7.0 degrees on supine side-bending radiographs, 13.3 degrees +/- 5.7 degrees on traditional FBR, 11.3 degrees +/- 4.5 degrees at the lowest height using CH-FBR (lowest weight), and 7.8 degrees +/- 4.1 degrees at the optimized height using CH-FBR (maximal weight). Postoperatively, the mean Cobb angle was 9.1 degrees +/- 5.2 degrees . There was a significant difference found between supine side-bending radiograph and postoperative Cobb angle (P = 0.001), traditional FBR, and postoperative Cobb angle (P = 0.002). There was no significant difference found between optimized height CH-FBR and postoperative Cobb angle (P = 0.16). Correlation analysis indicated that the maximum height of CH-FBR positively correlated with maximum weight applied (r = 0.68, r= 0.46, P = 0.001). 3
36. Ni HJ, Su JC, Lu YH, et al. Using side-bending radiographs to determine the distal fusion level in patients with single thoracic idiopathic scoliosis undergoing posterior correction with pedicle screws. J Spinal Disord Tech. 2011;24(7):437-443. Observational-Tx 38 patients To evaluate a strategy to determine the distal fusion level in posterior pedicle screw correction of single thoracic idiopathic scoliosis. Minimum follow-up was 2 years. The mean preoperative thoracic curve was 48.4+/-9.2 degrees and 12.6+/-6.1 degrees at final follow-up, resulting in a mean correction of 74.7%+/-8.5%. The mean preoperative compensatory lumbar curve of 23.7+/-7.5 degrees was 6.3+/-4.8 degrees at final follow-up. A change in lumbar lordosis from -41.2+/-11.9 degrees preoperatively to -38.2+/-9.9 degrees at final follow-up occurred. All patients achieved coronal balance and no decompensation or adding-on phenomenon was observed. Compared with the recommended fusion end by the Harrington stable zone method, 86.9% patients were saved 1 or more motion segment. 2
37. Watanabe K, Kawakami N, Nishiwaki Y, et al. Traction versus supine side-bending radiographs in determining flexibility: what factors influence these techniques? Spine (Phila Pa 1976). 2007;32(23):2604-2609. Observational-Dx 229 patients To evaluate a Cobb angle in standing position, patient age, the level of the apex, and the number of involved vertebrae in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. A total of 219 curves were observed in MT lesions. The traction flexibility rate (FR) was higher than the side-bending FR at angle of > or = 60 degrees (P = 0.02), in patients younger than 15 years (P = 0.02), in curves whose apex was located at T4-T8/T9 (P = 0.01), in curves whose involved vertebrae were 6 or 7 (P = 0.02), and at kyphosis angle between 10 degrees and 39 degrees (P = 0.02). In 96 TL/L curves, side-bending FR was higher at angle of < 60 degrees (P < 0.01). In 163 PT curves, traction FR was higher at angles of > or = 40 degrees (P = 0.02). 3
38. Cheh G, Lenke LG, Lehman RA, Jr., Kim YJ, Nunley R, Bridwell KH. The reliability of preoperative supine radiographs to predict the amount of curve flexibility in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32(24):2668-2672. Observational-Dx 675 patients To determine the reliability of supine long-cassette radiographs as compared with side-bending films in predicting curve flexibility in operative cases of adolescent idiopathic scoliosis (AIS). For Group I, MT supine films were highly predictive of MT side-bending while TL/L supine films were highly predictive of TL/L side-bending and standing films. An equation was derived to predict the value of the side-bending radiographs for each part of the curve. For Group II, MT supine films were highly predictive of MT side-bending and standing films. TL/L supine films were highly predictive of TL/L side-bending and standing films. Contingency table analysis for Group I resulted in the supine film providing a strong statistical ability to predict a nonstructural PT curve (sensitivity = 0.952, PPV = 0.864, NPV = 0.865) and also a nonstructural TL/L curve (sensitivity = 0.958, PPV = 0.916). Similarly, in Group II, we found a strong statistical ability to predict a nonstructural PT (sensitivity 1.00, PPV = 0.982, NPV = 1.00) and a nonstructural MT curve (sensitivity 0.789, specificity = 0.842, PPV = 0.833, NPV = 0.80). 3
39. Knott P, Mardjetko S, Nance D, Dunn M. Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006;31(24):E911-915; discussion E916. Observational-Dx 28 patients To measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS). In measurement of a static plastic model, the machine measured curves with a standard deviation of +/-1 degrees in trunk rotation and +/-2 degrees in curve measurement. Error increased with a real patient. Thirty-six comparisons in the thoracic spine, and 19 comparisons in the lumbar spine, were made between measurements using the Orthoscan and radiographs. Mean curves in the 2 groups were not significantly different and had poor-to-moderate correlation. Longitudinal evaluation included 47 curves in 28 patients. The Orthoscan predicted the radiograph change within an acceptable range 55.3% of the time. 3
40. Liu J, Shen J, Zhang J, et al. The position of the aorta relative to the spine for pedicle screw placement in the correction of idiopathic scoliosis. J Spinal Disord Tech. 2012;25(4):E103-107. Observational-Dx 47 patients To evaluate the relative position of the aorta to the spine by the axial CT scans in patients with right thoracic idiopathic scoliosis, and to discuss the safe trajectory and screw length for posterior pedicle screw placement. The values of angles alpha and beta had a tendency of first increasing and then decreasing, and increasing again from T4 to T12. The lowest value of angle alpha occurred at T10 (7.45+/-6.10 degrees), followed by T4 (8.89+/-6.49 degrees), T11 (9.13+/-7.59 degrees), and T9 (9.74+/-6.11 degrees). PAD and AXD values had a tendency of decreasing first and then increasing from T4 to T12. The lowest values of PAD and AXD occurred at T6; 25.94+/-5.33 and 23.64+/-6.53 mm, respectively. From the cephalad to the caudal spine, angle gamma increased first and then decreased. The highest value occurred at T7 (2.32+/-6.83 degrees), which rotated to the right side. The second largest value occurred at T8 (2.23+/-7.76 degrees). Statistical analysis indicated that the apical vertebral translation and vertebral rotation angle were significantly positively correlated to angles alpha and beta (P<0.05). 3
41. Malfair D, Flemming AK, Dvorak MF, et al. Radiographic evaluation of scoliosis: review. AJR Am J Roentgenol. 2010;194(3 Suppl):S8-22. Review/Other-Dx N/A To focus on adolescent idiopathic scoliosis as a framework for understanding the general concepts in the radiographic evaluation of the scoliotic spine. No abstract available. 4
42. Singhal R, Perry DC, Prasad S, Davidson NT, Bruce CE. The use of routine preoperative magnetic resonance imaging in identifying intraspinal anomalies in patients with idiopathic scoliosis: a 10-year review. Eur Spine J. 2013;22(2):355-359. Review/Other-Dx 206 patients To quantify the frequency of previously unidentified spinal cord anomalies identified by routine preoperative magnetic resonance imaging (MRI), in patients planned for surgical scoliosis correction. Twenty of 206 patients (9.7 %) were diagnosed with an unexpected intraspinal anomaly on routine preoperative MRI. In all cases, a neurosurgical opinion was sought prior to further intervention. Of the 20 patients, 11 underwent a neurosurgical procedure (de-tethering of cord, decompression of Chiari, decompression of syrinx). There was no statistically significant difference between the group of patients who had intrinsic spinal cord anomalies on preoperative MRI and those did not have a cord abnormality with regard to age at presentation, gender, side of dominant curve and degree of curve (p < 0.05). 4
43. Wu L, Qiu Y, Wang B, Zhu ZZ, Ma WW. The left thoracic curve pattern: a strong predictor for neural axis abnormalities in patients with "idiopathic" scoliosis. Spine (Phila Pa 1976). 2010;35(2):182-185. Review/Other-Dx 68 patients To investigate the prevalence of neural axis abnormalities in asymptomatic patients with "idiopathic" left thoracic scoliosis. Neural axis abnormalities were detected in 37 (54%) patients, including Chiari 1 malformation in 15 patients, Chiari 1 malformation with syringomyelia in 10, Chiari 1 malformation with syringomyelia and tethered cord in 1, Chiari 1 malformation with syringomyelia and diastematomyelia in 1, syringomyelia in 8, syringomyelia with tethered cord in 1, and arachnoidal cyst in cerebellomedullary cistern in 1 patient. There were statistically significant differences between patients with and without neural axis abnormalities regarding gender and curve severity (P < 0.05). 4
44. Magge SN, Smyth MD, Governale LS, et al. Idiopathic syrinx in the pediatric population: a combined center experience. J Neurosurg Pediatr. 2011;7(1):30-36. Review/Other-Dx 48 patients To present the combined data of 2 major pediatric neurosurgical centers to describe the author's experience with the discovery of a syrinx in a child Forty-eight patients met the criteria for idiopathic syrinx during this period, and in 32 of them detailed follow-up imaging was available. Discovery of a syrinx was incidental in 6 patients, whereas the others were referred for imaging because of the presence of pain, neurological symptoms, scoliosis, or skin markings. The average age at the first MR imaging session was 9.7 years, with a mean syrinx size of 4 mm (range 1.2-9.4 mm). The majority (52%) of patients had a thoracic syrinx, with the average lesion spanning 7.1 vertebral levels. The average follow-up was 23.8 months (range 2-64 months), and subgroups of patients with < 3 years and >/= 3 years of follow-up were independently reviewed. Overall, symptoms improved in 34% and worsened in 9%; 57% of the patients remained asymptomatic or stable. Radiographically (in the subgroup of 32 patients with detailed follow-up imaging), syrinx size decreased in 25% of patients, increased in 12.5%, and remained unchanged in 62.5%, with no apparent correlation between change in syrinx size and clinical symptoms. 4
45. Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ. Management of isolated syringomyelia in the paediatric population--a review of imaging and follow-up in a single centre. Br J Neurosurg. 2013;27(5):683-686. Review/Other-Dx 39 patients To assess the natural history of isolated syringomyelia in children. Thirty-nine patients were included with a mean age at diagnosis of 10.6 years. The average syrinx AP diameter was 3.30 mm. The rostrocaudal length of the syringes varied between 2 and 19 vertebral bodies. Twenty-seven out of 39 syringes were thoracic in origin. There were 3 and 6 syringes involving the cervicothoracic and thoracolumbar regions, respectively, with 3 involving the cervical area only. Eleven out of 39 (Group I) patients were found "incidentally" during work-up for adolescent idiopathic scoliosis and these were considered as a separate group. These patients did not have any significant symptoms and were discharged following their scoliosis correction surgery. Syrinx was incidental in 14 further patients (Group II). Of the 14 patients, 11 remained asymptomatic with no change in syrinx morphology throughout follow up. Of the 14 patients, 3 were lost to follow-up. Of the 39 patients, 14 (Group III) presented with progressive back pain without any obvious clinical cause. Of the 14, 10 either improved or remained the same. Of the 14 patients, 3 underwent lumbar puncture, 1/14 having myelography. All 4/14 patients reported significant pain reduction on follow up following intervention. 4
46. Sha S, Zhang W, Qiu Y, Liu Z, Zhu F, Zhu Z. Evolution of syrinx in patients undergoing posterior correction for scoliosis associated with syringomyelia. Eur Spine J. 2015;24(5):955-962. Observational-Tx 22 patients To investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis associated with idiopathic syringomyelia (IS). Postoperative percent correction of the primary curve averaged 64.0 +/- 15.7% and was well maintained (58.5 +/- 11.5%) at latest evaluation. Regarding syrinx size, although paired t test revealed no statistically significant difference between pre- and postoperative maximal syrinx/cord ratios (0.44 versus 0.41; P > 0.05), 10 of 22 (45.5%) patients were found to meet the criteria for significant syrinx resolution. Additionally, 11 (50.0%) patients had syrinx stabilization, whereas syrinx deterioration was observed only in 1 case (4.5%) at final follow-up. Using Spearman correlation test, improvement rate of the maximal syrinx/cord ratio was found to be strongly related to the coronal percent correction of the primary curve (r = -0.547, P = 0.008). There were no neurologic or other major complications related to the surgery. 2
47. Krieger MD, Falkinstein Y, Bowen IE, Tolo VT, McComb JG. Scoliosis and Chiari malformation Type I in children. J Neurosurg Pediatr. 2011;7(1):25-29. Observational-Dx 79 patients To evaluate the effects of a craniotomy for Chiari malformation Type I (CM-I) decompression on scoliosis in children and adolescents. On the MR images obtained 6 months postoperatively, 70 patients (89%) had a significant reduction in the syrinx with an associated ascent of the cerebellar tonsils. Persistent large syringes were treated with reoperation in 6 patients, and shunts were inserted for hydrocephalus in 2 patients. None of the 49 patients with curves less than 20 degrees had progression of their curvature postoperatively. Of the 30 patients with curves greater than 25 degrees , 9 had no change in the scoliosis or had a reduction in curve magnitude after Chiari decompression. This group required no further therapy and was effectively treated by Chiari decompression alone. Twenty-one patients required further scoliosis treatment after Chiari decompression; 12 required orthotic treatment, 11 received spinal instrumentation and fusion surgery, and 2 received orthoses followed by fusion and instrumentation. The severity of the curvature beyond 20 degrees did not predict the need for spinal surgery. 3
48. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4