The prevalence of abnormal preoperative neurological examination in scheuermann kyphosis: Correlation with x-ray, magnetic resonance imaging, and surgical outcome

Woojin Cho, Lawrence G. Lenke, Keith H. Bridwell, Guangxun Hu, Jacob M. Buchowski, Ian G. Dorward, Joshua M. Pahys, Samuel K. Cho, Matthew M. Kang, Lukas P. Zebala, Linda A. Koester

Research output: Contribution to journalArticle

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Abstract

STUDY DESIGN.: Retrospective. OBJECTIVE.: The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment. SUMMARY OF BACKGROUND DATA.: There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis. METHODS.: Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients 1/4 charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination. RESULTS.: There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0° (AbN) and 72.5° (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI. CONCLUSION.: The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues.Level of Evidence: 4.

Original languageEnglish (US)
Pages (from-to)1771-1776
Number of pages6
JournalSpine
Volume39
Issue number21
DOIs
StatePublished - Oct 1 2014

Fingerprint

Scheuermann Disease
Neurologic Examination
Magnetic Resonance Imaging
X-Rays
Spinal Cord Diseases
Anterior Spinal Artery Syndrome
Intervertebral Disc Displacement
Kyphosis
Myelography
Paresthesia
Physical Examination
Pathologic Constriction
Magnetic Resonance Spectroscopy
Thorax

Keywords

  • abnormal neurological examination
  • magnetic resonance imaging
  • prevalence
  • Scheuermann kyphosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

The prevalence of abnormal preoperative neurological examination in scheuermann kyphosis : Correlation with x-ray, magnetic resonance imaging, and surgical outcome. / Cho, Woojin; Lenke, Lawrence G.; Bridwell, Keith H.; Hu, Guangxun; Buchowski, Jacob M.; Dorward, Ian G.; Pahys, Joshua M.; Cho, Samuel K.; Kang, Matthew M.; Zebala, Lukas P.; Koester, Linda A.

In: Spine, Vol. 39, No. 21, 01.10.2014, p. 1771-1776.

Research output: Contribution to journalArticle

Cho, W, Lenke, LG, Bridwell, KH, Hu, G, Buchowski, JM, Dorward, IG, Pahys, JM, Cho, SK, Kang, MM, Zebala, LP & Koester, LA 2014, 'The prevalence of abnormal preoperative neurological examination in scheuermann kyphosis: Correlation with x-ray, magnetic resonance imaging, and surgical outcome', Spine, vol. 39, no. 21, pp. 1771-1776. https://doi.org/10.1097/BRS.0000000000000519
Cho, Woojin ; Lenke, Lawrence G. ; Bridwell, Keith H. ; Hu, Guangxun ; Buchowski, Jacob M. ; Dorward, Ian G. ; Pahys, Joshua M. ; Cho, Samuel K. ; Kang, Matthew M. ; Zebala, Lukas P. ; Koester, Linda A. / The prevalence of abnormal preoperative neurological examination in scheuermann kyphosis : Correlation with x-ray, magnetic resonance imaging, and surgical outcome. In: Spine. 2014 ; Vol. 39, No. 21. pp. 1771-1776.
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T1 - The prevalence of abnormal preoperative neurological examination in scheuermann kyphosis

T2 - Correlation with x-ray, magnetic resonance imaging, and surgical outcome

AU - Cho, Woojin

AU - Lenke, Lawrence G.

AU - Bridwell, Keith H.

AU - Hu, Guangxun

AU - Buchowski, Jacob M.

AU - Dorward, Ian G.

AU - Pahys, Joshua M.

AU - Cho, Samuel K.

AU - Kang, Matthew M.

AU - Zebala, Lukas P.

AU - Koester, Linda A.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - STUDY DESIGN.: Retrospective. OBJECTIVE.: The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment. SUMMARY OF BACKGROUND DATA.: There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis. METHODS.: Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients 1/4 charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination. RESULTS.: There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0° (AbN) and 72.5° (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI. CONCLUSION.: The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues.Level of Evidence: 4.

AB - STUDY DESIGN.: Retrospective. OBJECTIVE.: The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment. SUMMARY OF BACKGROUND DATA.: There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis. METHODS.: Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients 1/4 charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination. RESULTS.: There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0° (AbN) and 72.5° (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI. CONCLUSION.: The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues.Level of Evidence: 4.

KW - abnormal neurological examination

KW - magnetic resonance imaging

KW - prevalence

KW - Scheuermann kyphosis

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