Demonstration of the importance of MRI in preoperative evaluation of adolescent idiopathic scoliosis.

Abstract

To demonstrate the utility of routine preoperative magnetic resonance imaging (MRI) in detecting neural axis abnormalities in presumed adolescent idiopathic scoliosis (AIS) patients. A retrospective analysis of pediatric patients who underwent posterior spinal instrumentation and fusion (PSIF) for presumed AIS at a single institution over 14 years. Patients with syndromic, congenital, or neuromuscular scoliosis were excluded. MRI findings, history and exam findings, and neurosurgery consultation/intervention were documented. Among 233 patients with presumed AIS who underwent routine preoperative MRI, 24 (10.3%) had positive findings, including Arnold-Chiari malformations, syringomyelia, and tethered cords. Five patients (2.1%) required neurosurgical intervention before PSIF; only one exhibited an atypical curve pattern before MRI. The remaining cases did not alter surgical plans but required consultation with neurosurgery. Routine MRI in presumed AIS patients identified neural axis abnormalities in a subset of patients who otherwise lacked neurological indicators. These findings support the consideration of preoperative MRI in AIS management to optimize surgical planning and patient safety.