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news News Thursday, March 22, 2018 Thursday, March 22, 2018 9:29 AM - Thursday, March 22, 2018 9:29 AM

MRI in early onset scoliosis: Is universal screening necessary?

MRI in early onset scoliosis: Is universal screening necessary?

One of the core aspects of the Shriners Hospitals for Children’s mission is to conduct innovative research that will improve the lives of children. Research is an important aspect of evidenced-based care provided at all 22 Shriners Hospitals for Children locations and the Lexington facility is no exception. Since the inception of Shriners Hospitals for Children Medical Center — Lexington’s research program in 1995, over 150 funded research projects have been conducted. These projects were made possible because of the support from Shriners Hospitals for Children Research Advisory Board and Kosair Charities, along with a few other private foundations, totaling $7.5 million. In addition, the Lexington Shriners Medical Center’s research program has completed almost 150 unfunded research projects. All of these projects combined have resulted in 390 scientific presentations to national and international conferences and in 144 scientific publications to peer-reviewed journals.

A recent research project conducted by Shriners Medical Center involved children less than 5 years of age, diagnosed with early onset scoliosis (a curvature of the spine). For young children diagnosed with early onset scoliosis, having an MRI is recommended in order to rule out abnormalities of the spine and central nervous system. However, an MRI screening, like any medical procedure, has inherent costs and potential risks. The MRI is done under anesthesia when the child is under the age of 5. Anesthesia helps the patient to lie perfectly still with little to no movement during the procedure in order to produce the most accurate results possible. Typically, children with progressive scoliosis will require multiple exposures to anesthesia. Multiple exposures to anesthesia may result in adverse effects in children. Limiting the frequency of MRI evaluations, therefore, is of paramount interest, and is a factor that led to this study. 

Our researchers evaluated 53 patients, under the age of 5, with progressive scoliosis. All 53 patients had undergone the initial MRI screening. First, we grouped the 53 patients into two groups based upon whether they had a normal or abnormal MRI finding. We compared the two groups and found that patients with a curve of 30 degrees or higher were 27 times more likely to have an abnormal MRI finding.

What does this mean clinically? In our sample population, 20 fewer children would have undergone MRI evaluations, eliminating anesthesia risks for the child and decreasing financial costs to families and institutions. Our pediatric orthopaedic surgeons are now able to use the curve magnitude of 30 degrees as a threshold to determine the timing of MRI screenings for their patients. For those patients with no unusual findings on radiographs or physical exam, who have a curve less than 30 degrees, MRI screening may be delayed until the curve progresses above the 30 degree threshold.

Every research project conducted by our staff at Lexington Shriners Medical Center strives to put the “patient and family first.” No matter the research question, our overall goal is to contribute generalizable knowledge that will continually improve the health care we provide.  At Lexington Shriners Medical Center, research matters because our patients and families matter.

A happy patient stands next to his casts

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