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Oral presentation | Open | Published:

The use of axial loaded MRI in place of radiographs for surveillance of Adolescent Idiopathic Scoliosis: one practice's experience and recommendations

Background

There have been several recent research studies published suggesting that MRI scans may prove to be a viable alternative to radiographs in the surveillance of curves for patients with AIS.

This orthopaedic practice began a prospective study of whether these scans provided reliable curve measurements when compared to traditional radiographs. While enrolling patients in this study and obtaining axial loaded MRI's during regular clinic hours, we were able to gain experience in how to schedule patients, obtain scans efficiently, provide axial loading to simulate gravity during the scan (Figure 1), use MRI images to obtain Cobb angles, and incorporate this all into our regular patient care routine.

figure1

Figure 1

Methods

Our experiences are recorded in order to share them and to give recommendations to physicians interested in incorporating these techniques into their scoliosis clinics.

Results and conclusion

Our experience using axial loaded MRI to evaluate scoliosis curves led to a number of important lessons.  We found that parents of adolescent patients were very aware of the dangers of repeated spinal radiographs, and were very interested in using a non-radiographic method.  They were not overly concerned with the increased cost, and were willing to go through a more inconvenient process to obtain the MRI compared with the ease of obtaining an x-ray in the clinic.  The MRI scan was initially about ten times the cost of a radiograph, but after working on a shortened protocol to obtain only a few coronal images on the MRI, we were able to bring the cost of the MRI down so that it was only about two times the cost of a radiograph.  Doing an abbreviated MRI during clinic added between 30 and 60 minutes to the patients office visit time.  Fitting in scoliosis MRI's between those of regular MRI patients was difficult, and sometimes resulted in increased waiting time for the scoliosis patients.  Having the patient stand in the waiting room rather than sit helped alleviate the need to put on the axial loading device for 10 minutes before having the patient enter the MRI scanner [15].

References

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    Levy AR, Goldberg MS, Mayo NE, et al : Reducing the lifetime risk of cancer from spinal radiographs among people with adolescent idiopathic scoliosis. SPINE. 1996, 21 (13): 1540-7. 10.1097/00007632-199607010-00011. discussion 1548

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    Gassel F, Schmitz A, Koenig R, et al : Calculation of 3-D deformity in scoliosis by MRI of the total spine in two perpendicular reconstructed planes. Z Orthop Ihre Grenzgeb. 2002, 140: 165-70. 10.1055/s-2002-31535.

  3. 3.

    Knott Patrick, et al> : Sagittal Cobb-angle measurements in scoliosis with MRI whole spine imaging. Z Orthop Ihre Grenzgeb. 2001, 139: 304-7. 10.1055/s-2001-16915.

  4. 4.

    Knott Patrick, et al> : A new method of MR total spine imaging for showing the brace effect in scoliosis. J Orthop Sci. 2001, 6: 316-9. 10.1007/s007760100025.

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    Kimura S, Steinbach GC, Watenpaugh DE, et al : Lumbar spine disc height and curvature responses to an axial load generated by a compression device compatible with magnetic resonance imaging. SPINE. 2001, 26 (23): 2596-600. 10.1097/00007632-200112010-00014.

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Author information

Correspondence to PT Knott.

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Keywords

  • Adolescent Idiopathic Scoliosis
  • Idiopathic Scoliosis
  • Cobb Angle
  • Visit Time
  • Scoliosis Patient