ABSTRACT

Aim and Purpose:

It is very difficult to manage the treatment of early onset scoliosis (EOS). It is necessary to diagnose and start the treatment of patients with EOS as early as possible, and to plan the treatment well. We investigated the pathologies seen in spinal, orthopedic, cardiovascular and other organ systems caused by different etiologies in EOS with the help of magnetic resonance imaging (MRI) and other diagnostic methods, based on etiological reasons.

Materials and Methods:

We evaluated 62 EOS patients (26 congenital, 21 neuromuscular, 10 syndromic and 5 idiopathic) who received spinal MRIs, and who were operated on and/or managed due to scoliosis between the years of 2005–2011. The mean age at MRI evaluation was 4.3 years of age (3 months–11 years 10 months), and 38 patients were female and 24 were male. For all patients, we investigated the intraspinal, extraspinal and additional organ anomalies with MRI. We measured the coronal and sagittal plane deformity of the spine with the Cobb method. We also investigated the orthopedic pathologies clinically and radiologically, and the additional organ anomalies with abdominal ultrasound and echocardiogram.

Results:

We found intraspinal anomalies in 48 patients (77.4%), extraspinal anomalies in 46 patients (74.1%), and additional organ anomalies in nine patients (14.5%). We documented 98 intraspinal and 101 extraspinal pathologies with MRI. When evaluated according to the spinal regions, 50 (80.6%) of the patients had pathologies in thoracic, 38 (61%) had lumbar, 28 (45%) cervical, and four (6.4%) had pathologies in sacral areas. The most common intraspinal anomaly, observed at a rate of 54.8% (34 patients), was syringomyelia. Intraspinal anomalies were most common in neuromuscular scoliosis patients, at a rate of 55.1% (54 pathologies). The most frequent extraspinal anomaly was hemivertebrae, seen in 38.7% of patients (24 patients). Extraspinal anomalies were most commonly observed in congenital scoliosis patients, at a rate of 62.37% (63 pathologies). The mean Cobb angle in all cases was measured as 46.6° (10–113°). We found increased kyphosis in 18 (29%) cases and lordosis in four (6.4%) cases. In 37 (59.6%) of the patients, an additional 56 orthopedic pathologies were found. The most commonly co-observed problems were motor weakness in the lower extremities in 12 patients (21%), hip dysplasia in nine (16%) patients, and thorax deformities in nine (16%) patients. Orthopedic pathologies were most commonly observed in neuromuscular scoliosis patients, at a rate of 32% (19 patients). We found cardiovascular anomalies in seven patients (11.2%) (most commonly ASD), urogenital anomalies in 11 patients (17.74%) (most frequently bowel and bladder incontinence), and other organic defects in 12 patients (19.35%) (most frequently inguinal hernia). 33 (53.2%) patients had previously received surgery. 18 (29%) of them had had neurosurgical operations, 15 (24.1%) were operated on for orthopedic or other organ anomalies, and only in seven (11.2%) cases were VEPTR (4), telescopic rod (1), epiphysiodesis (1) or hemivertebra (1) excision applied.

Discussion:

Even though scoliosis has different etiologies, many spinal and other organ anomalies tend to accompany EOS. Intraspinal anomalies are frequently observed with NS, with syringomyelia as the most common intraspinal anomaly. Extraspinal anomalies of the spine are most frequently seen with CS, and the most common anomaly is hemivertebrae. The thoracic vertebrae are most affected. Orthopedic pathologies are mostly seen with NS. The most commonly encountered cardiovascular anomaly is ASD, which is seen together with SS. In addition to careful clinical and radiological investigations, early MRI investigation can lead to better understanding of accompanying anomalies.