Are there magnetic resonance imaging‐detectable pathologies in idiopathic scoliosis patients?

Scoliosis may be a spinal manifestation of underlying disease, therefore, imaging plays a very important role in determining the underlying aetiology of so‐called ‘idiopathic’ scoliosis. If underlying intraspinal defects go unrecognised and untreated, irreversible neurological deficit can develop. Magnetic resonance imaging (MRI) is the modality of choice for imaging the spinal canal, albeit controversially. This literature review has been designed to find out whether there are associated MRI‐detectable pathologies in idiopathic scoliosis patients. If so, what is the incidence of such abnormalities? And when would MRI evaluations be warranted for idiopathic scoliosis patients? Twenty studies relating to MRI and scoliosis met the criteria and were used to perform a meta‐analysis. The majority of the articles took the view that a non‐invasive investigation which does not use ionising radiation and which can reliably exclude such intraspinal occult disease should not be withheld. Results showed that, in a population of 1398 idiopathic scoliosis patients, MRI detected 226 (16%) related intraspinal pathologies. The most common pathologies were 73 syringomyelias (32%) and 44 Chiari malformations (19%). In conclusion, until further investigation is conducted into the clinical significance of the intraspinal diseases with idiopathic scoliosis, whole spine MRI evaluations with a variety of imaging planes and pulse sequences are warranted in all idiopathic scoliosis patients, even if it is from a defensive risk management viewpoint.