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Chiropractic Research Review

Using MRI to Identify Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is characterized not only by global changes in the vertebral column, but also by local changes in individualized vertebrae. To date, the individual vertebral changes remain poorly identified, especially pedicle morphology.

Unfortunately, most pedicle asymmetry studies have involved patients who are either in the late stages of AIS, or outside the adolescent age group. Additionally, the definitions used to measure vertebral morphology are inconsistent, and in most cases, cannot be applied to both normal and deformed vertebrae, or to images acquired via different imaging modalities.

This study had two objectives: to assess pedicle asymmetry in both normal patients and AIS patients in the early stages of scoliosis development, and to determine if patients with AIS exhibited a consistent vertebral morphology. The researchers examined MRI images from 76 pedicles (38 vertebrae) of eight normal patients and 80 pedicles (40 patients) of 10 patients with AIS. All AIS patients were carefully screened to ensure that their scoliosis was idiopathic and in the early stages of the disease.

The authors were surprised to find that vertebrae from subjects without AIS demonstrated asymmetries in pedicle width, length, area and perimeter. The sum of the left pedicle and lamina lengths was significantly greater in "normal" subjects. Vertebrae of AIS patients also demonstrated significant asymmetries; however, there was no trend in the side of the asymmetry. Of note, there was no association between a greater pedicle/laminar length in individual vertebrae and the concavity or convexity of the scoliosis. This relationship was reversed when considering the sum of the pedicle/lamina length for several segments - the sum of pedicle/lamina lengths for several vertebrae were greater on the convex side of the curve.

The researchers note that while the vertebrae of AIS patients demonstrated significant asymmetry compared to normal patients, the direction of the asymmetry was inconsistent, which suggests that "the patterns of vertebral morphology in AIS might depend on the specific cause." They add that further research into the relationship between vertebral morphology and specific causes of AIS would provide insight into diagnosis, treatment and etiology.

While chiropractors see clinical improvements in scoliosis patients, this paper demonstrates that there may be more to managing these patients than meets the eye. Certainly, how or if measurements of axial images of the spine may influence management is of interest when considering neural plasticity inside the spinal canal with variations in diameter.

Rajwani T, Bagnall KM, Lambert R, et al. Using magnetic resonance imaging to characterize pedicle asysmmetry in both normal patients and patients with adolescent idiopathic scoliosis. Spine, April 1, 2004;29(7):e145-52.

Chiropractic Research Review

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