Spinal Pathologies with Scoliosis

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Spondilolisthesis: 7.2% (13). • CS: 1, TS: 0, LS: 6 (p=0.002). • Diastematomyelia (split cord): 5.5% (10). • CS: 2, TS: 4, LS: 4 (p>0.05). • Tethered cord: 5.5% (10).
S 62

Spinal Pathologies With Scoliosis Mehmet B.Balioglu, Osman Cimen, M.Akif Kaygusuz Baltalimani Bone Disease Teaching Hospital Istanbul, Turkey

CONCURRENT SESSIONS - S62

Spinal Pathologies with Scoliosis Author

Relationships Disclosed

 Mehmet Bulent Balioglu

No Relationship

 Osman Cimen

No Relationship

 M.Akif Kaygusuz

No Relationship

Introduction •The objective of our study was to identify the frequency and location of scoliotic pathologies using MRI.

Method • Between 2000-2010, 402 patients diagnosed; • Idiopathic, • Congenital, • Neuromuscular and • Syndromic scoliosis were retrospectively evaluated to identify the frequency and location: • Cervical, • Thorasic, • Lumbar areas of related pathologies. Diagnosis

Number

Gender Concamitant Age Surgery F M Pathologies (%) 236 54 14.9 (11-22) 71 52 (17.9%)

CS

TS

LS

9

25

21

Idiopathic Scoliosis

290

Congenital Scoliosis

48

31 17

15 (5-35)

43 (89.5%)

5

15

27

23

Neuromuscular S.

44

30 14

15.3 (4-30)

30 (68.1%)

5

15

15

17

Syndromic Scoliosis

20

6

14 (10-18)

12 (60%)

4

5

7

-

Total

402

14

303 99 14.8 85 137 (34%) 44 (24.5%) 74 (41.3%) 61 (34%) Frequency and location of scoliotic pathologies

Results • 290 patients were diagnosed as idiopathic scoliosis (IS): • Gender: 236 F, 54 M • Age: 14.9 y (11-22) • Concomitant pathologies: 52 (17.9%) • Cervical spine (CS): 9 (16.3%) • Thoracic spine (TS): 25 (45.4%) • Lumbar spine (LS): 21 (38.1%) 16%

18% 38% 82% Idiopathic S. / MRG

Normal Pathology

46% Intraspinal pathology (%)

CS TS LS

Results • Congenital scoliosis: 48 • Gender: 31 F, 17 M • Age: 15 y (5-35) • Concomitant pathologies: 43 (89.5%) • CS: 15 (34.8%) • TS: 27 (41.5%) • LS: 23 (35.8%)

Congenital Scoliosis

10%

35% Pathology Normal 90% Congenital S./ MRI

23% 42%

Intraspinal pathology

CS TS LS

Results • Neuromuscular scoliosis: 44 • Gender: 30 F, 14 M • Age: 15.3 y (4-30) • Concomitant pathologies: 30 (68.1%) • CS: 15 (31.9%) • TS: 15 (31.9%)

CP + Syringohydromyelia

• LS: 17 (36.1%)

32%

36%

32% 68% Neuromuscular S. / MRI

Pathology Normal

Myelomeningocel (Spina Bifida)

32% Intraspinal pathology

CS TS LS

Results • Syndromic scoliosis : 20 • Gender: 6 F, 14 M • Age: 14 y (10-18) • Concomitant pathologies: 12 (60%) • CS: 5 (41.6%) • TS: 7 (58.3%) • LS: (-) Escobar

42%

Pathology

40%

Jarcho-Levin Syndrome

58% 60%

Syndromic scoliosis / MRI

Normal Intraspinal pathology

CS TS

Results • Total of 179 pathologies (137 patients) were diagnosed. • Most effected areas: • TS: 41,3% (74) • LS: 34% (61) • CS: 24.5% (44)

TS

LS

CS

74 61 44

TS

LS

CS

Results • Most common pathologies: • Syringomyelia: 37.4% (67 cases) • CS: 22, TS: 36, LS: 9 (p>0.05)

• Congenital vertebral anomalies: 22.3% (40)

CP + Syringohydromyelia

• CS: 8, TS: 22, LS: 10 (p>0.05)

Syringohidromyelia + Cranioservical pathology

• Spondilolisthesis: 7.2% (13) • CS: 1, TS: 0, LS: 6 (p=0.002)

• Diastematomyelia (split cord): 5.5% (10) • CS: 2, TS: 4, LS: 4 (p>0.05)

• Tethered cord: 5.5% (10) • CS: 0, TS: 0, LS: 10 (p>0.05)

• Schmorl nod: 4.4% (8)

Hemivertebra

Neuroenteric Cyst + Syringomyelia + Hemivertebra

• CS: 0, TS: 5, LS: 3 (p>0.05)

• Dural echtasia: 2.2% (4) • CS: 0, TS: 0, LS: 4 (p=0.019) Spondilolisthesis

Tethered Cord + Diastometamyelia

Conclusion • Pathologies vary according to scoliosis type. • MRI is crucial in detecting these pathologies. • In our study the average rate of spinal pathologies in scoliotic patients was 34%. • • • •

IS 17.9% SS 60% NS 68.1% CS 89.5%

Most common pathologies

Diagnosis

%

Number CS

TS

LS

(p)

Syringomyelia

37.4

67

22

36

9

p>0.05

Congenital Vertebral Anomalies

22.3

40

8

22

10

p>0.05

Spondylolisthesis

7.2

13

1

-

1

p=0.002

Diastematomyelia

5.5

10

2

4

4

p>0.05

Tethered spinal cord

5.5

10

-

-

10

p>0.05

Schmorl

4.4

8

-

5

3

p>0.05

Dural Ectasia

2.2

4

-

-

4

p=0.019

Cerebellar tonsillar hernia

1.6

3

-

-

3

p=0.009

C1/C2 cervical pathologia

1.6

3

3

-

-

p=0.009

Conclusion • The most common pathology was syringomyelia and the most commonly effected spinal area was Thorasic spine. • The rate of spinal pathologies in Congenital scoliosis were the highest among all scolitic deformities.