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Congenital scoliosis, cervical MRI changes and concomitant malformations

Author: WangZiJia
Tutor: ShenJianXiong
School: Beijing Union Medical College
Course: Clinical
Keywords: congenital scoliosis magnetic resonance imaging intraspinal anomaly congenital defects
CLC: R682.13
Type: PhD thesis
Year: 2010
Downloads: 11
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Study Design. A retrospective study is performed to evaluate the morphology of the cervical cord and hindbrain in congenital scoliosis by using magnetic resonance imaging (MRI). Associated congenital defects are also estimated. Objective. To evaluate the morphology of cervical cord and related structures, and assess the incidence of intraspinal anomaly and other organic defects associated with different types of congenital scoliosis at presentation.Summary of Background Data. MRI is widely investigated preoperatively in scoliosis. Morphology of the cervical cord and hindbrain in congenital scoliosis were rarely studied in literature. A high incidence of intraspinal abnormalities and other organ defects is reported in relation to congenital scoliosis. The prevalence of these problems varies with different types of deformities is rarely reported.Methods. This study was divided into two parts. Part I:A retrospective study was performed in126congenital scoliosis patients (mean age13yr,75F,51M) with MRI examination of the cervical cord and hindbrain. Measurements of the ratio of anteroposterior (AP) and transverse (TS) diameter of the cervical spinal cord were obtained. Cerebellar tonsillar level related to the basion-opsithion (BO) line, odontoid process level related to the BO line, angle between axis of cervical cord and medulla oblongata(a), angle between axis of BO line and medulla oblongata(β) were also measured. Part II:A retrospective study was performed in108congenital scoliosis patients (mean age14yr,66F,42M) who had MRI, echocardiography, renal ultrasound, and a thorough clinical assessment. The incidence of intraspinal anomaly and other organic defects associated with different types of congenital scoliosis was assessed.Results. Part Ⅰ:Cervical AP/TS ratio were increased in congenital scoliosis with lowing positiong of cerebellar tonsillar level and odontoid process level, increased a angle, and decreased β angle when compared with normal controls (P<0.05). Part Ⅱ:Intraspinal abnormalities were found in42patients (39%). These abnormalities were significantly more common in patients with with scoliosis resulting from segmentation defects (P<0.05). In60(56%) patients other organic defects were found. These defects were more common in patients with congenital scoliosis resulting from mixed defects. Cardiac defects were detected in20%and urogenital anomalies in16%of the patients.Conclusions. Our study revealed significantly abnormal morphology of cervical cord and hindbrain, suggesting the presence of tethering of the spinal cord along the longitudinal axis or the maldevelopment of the spinal cord. Magnetic resonance imaging should be an essential part in the routine evaluation of patients with congenital scoliosis to assess the associated congenital defects.

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