Thoracic Sagittal Plane Deformity: An Indicator of Syringomyelia

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Thoracic Sagittal Plane Deformity: An Indicator of Syringomyelia

The diagnosis of adolescent idiopathic scoliosis (AIS) has been characterized as one of exclusion; practitioners are required to confirm that patients presenting with scoliosis do not have any underlying condition that has contributed to or caused their deformity.

Previous research has reported that AIS patients tend to have both a coronal plane deformity and an associated sagittal plane deformity of an apical lordosis.
The authors of the present study anecdotally noticed a lack of the sagittal plane deformity in patients with scoliosis caused by syringomyelia, even when symptoms of the latter are subtle or entirely absent. Syringomyelia occurs when fluid-filled cavities form in the spinal cord, causing sensory loss, abnormal cutaneous abdominal reflex, sympathetic disturbances, upper extremity Charcot's joints, and other neurological signs and symptoms.
This retrospective radiology review evaluated the plain films of 93 patients with either idiopathic scoliosis or syringomyelia-associated scoliosis to determine their sagittal alignment. Particular attention was paid to lateral radiographs of the spine, assessing the presence or absence of a sagittal apical lordosis in the thoracic spine. Full-spine radiographs of 30 patients with MRI-confirmed syringomyelia-associated scoliosis (the study group) were compared to 54 patients with AIS but no spinal cord deformities on MRI (the control group).
Results showed that apical lordosis was present in 97% of patients in the control group and absent in 75% of patients in the study group. According to the authors, the presence of this deformity based on evaluation of vertebral body relationships was frequently obscured by rotational deformity on standard radiographs.
Conclusion: "A high statistically significant percentage of patients with syringomyelia-associated thoracic scoliosis do not demonstrate apical lordosis on lateral radiographs. When apical lordosis is not present in [such patients], strong consideration should be given to the possibility of the presence of syringomyelia, and acquisition of an MRI scan [should be] considered." The authors also note that their results reinforce the need to evaluate sagittal plane deformity when treating scoliosis, and that if apical lordotic deformity is absent, a diagnosis of AIS should be made with caution.
Ouellet JA, LaPlaza J, Erickson MA, et al. Sagittal plane deformity in the thoracic spine: a clue to the presence of syringomyelia as a cause of scoliosis. Spine, Sept. 15, 2003:28(18), pp2147-51.
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