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Intraspinal Anomalies Associated with Isolated Congenital Hemivertebra: The Role of Routine Magnetic Resonance Imaging
Philip J. BelmontJr., MD1; Timothy R. Kuklo, MD1; Kenneth F. Taylor, MD1; Brett A. Freedman, MD1; John R. Prahinski, MD1; Richard W. Kruse, DO2
1 Orthopaedic Surgery Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC 20307. E-mail address for T.R. Kuklo: timothy.kuklo@na.amedd.army.mil
2 Department of Orthopaedic Surgery, duPont Hospital for Children, Alfred I. duPont Institute, 1600 Rockland Road, Wilmington, DE 19803
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Army or the Department of Defense. All authors are employees of the United States government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.
Investigation performed at Alfred I. duPont Institute, Wilmington, Delaware, and Walter Reed Army Medical Center, Washington, DC

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Aug 01;86(8):1704-1710
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Abstract

Background: Previous studies have demonstrated high rates of intraspinal anomalies in patients with congenital scoliosis; however, various authors have not considered the presence of an isolated hemivertebra to be sufficient reason for further evaluation with magnetic resonance imaging. Consequently, the rate of magnetic resonance imaging-detected intraspinal anomalies and subsequent neurosurgical intervention in patients with a single hemivertebra is unknown. Therefore, we studied all patients with a hemivertebra, after eliminating patients with a myelomeningocele, to compare those who had a single hemivertebra with those who had a complex hemivertebral pattern.

Methods: A retrospective review of the history, physical examination findings, and magnetic resonance imaging findings for patients who had presented with at least one hemivertebra, excluding those who had a myelomeningocele, was conducted to identify the prevalence of intraspinal anomalies as seen on magnetic resonance imaging and the rate of subsequent neurosurgical intervention. Additionally, the diagnostic value of the history and the physical examination in predicting the presence of intraspinal anomalies was determined.

Results: One hundred and sixteen patients with congenital scoliosis and a curve that included at least one hemivertebra were identified. Seventy-six of these patients had had magnetic resonance imaging and were included in the present study. The mean age of these patients at the time of presentation was 4.9 years, and the mean duration of follow-up was 7.7 years. Twenty-nine patients had an isolated hemivertebra, and forty-seven patients had a complex hemivertebral pattern. Eight (28%) of the twenty-nine patients with an isolated hemivertebra and ten (21%) of the forty-seven patients with a complex hemivertebral pattern had an intraspinal anomaly that was detected with magnetic resonance imaging. Overall, an abnormal finding on the history or physical examination demonstrated an accuracy of 71%, a sensitivity of 56%, a specificity of 76%, a positive predictive value of 42%, and a negative predictive value of 85% for the diagnosis of an intraspinal anomaly. Three patients with an isolated hemivertebra and five patients with a complex hemivertebral pattern underwent neurosurgical intervention. All eight patients who underwent neurosurgical intervention had had detection of an intraspinal anomaly with magnetic resonance imaging, whereas only four of these patients (two of whom had an isolated hemivertebra and two of whom had a complex hemivertebral pattern) had had an abnormal finding on either the history or the physical examination.

Conclusions: Patients who have an isolated hemivertebra and those who have a complex hemivertebral pattern have similar rates of intraspinal anomalies that are detected with magnetic resonance imaging and similar rates of subsequent neurosurgical intervention. The history and physical examination findings are not predictive of intraspinal anomalies. Therefore, a magnetic resonance imaging evaluation of the entire spine should be considered for all patients with congenital scoliosis, including those with an isolated hemivertebra.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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