Whole-Spine Magnetic Resonance Imaging in Patients with... : Clinical Spine Surgery (original) (raw)

Original Article

Whole-Spine Magnetic Resonance Imaging in Patients with Neurofibromatosis Type 1 and Spinal Deformity

Ramachandran, Manoj MRCS*; Tsirikos, Athanasios I MD*; Lee, Joshua MRCS*; Saifuddin, Asif MRCP, FRCR†

From the *Spinal Deformity Unit and †Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom.

Received for publication March 3, 2004;

accepted May 14, 2004.

Reprints: Dr. A. Saifuddin, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK (e-mail: [email protected]).

Abstract

Objective:

Whole-spine magnetic resonance imaging (MRI) has been recommended in the preoperative evaluation of patients with neurofibromatosis type 1 (NF-1). However, no large study has identified the role of MRI in the classification and management of this condition. A retrospective study of 27 patients with NF-1, presenting with spinal deformity, who were investigated with plain radiographs and whole-spine MRI, was conducted to determine the role of whole-spine MRI in the classification and management of patients with NF-1 and spinal deformity.

Methods:

The medical records, radiographs, and MRI studies of 27 neurologically intact patients with NF-1 and spinal deformity, who had been followed for a minimum of 2 years, were reviewed.

Results:

The study group comprised 27 patients, 11 of whom were categorized as having nondystrophic and 16 as having dystrophic curves based on radiographic features. All patients had normal neurologic function. In the nondystrophic group, MRI identified dystrophic changes in four patients (associated with a high rate of curve progression in one). A high incidence of intraspinal and paraspinal neurofibromas was documented (overall 37%) in both nondystrophic and dystrophic groups. Significantly more tumors were identified adjacent to the convexity of the curve in the dystrophic group.

Conclusion:

In a mixed population of pediatric and adult patients with NF-1, normal neurologic function, and spinal deformity, MRI of the whole spine proved useful in the identification of occult vertebral dysplasia and in demonstration of intraspinal and paraspinal neoplasms.