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A functional magnetic resonance imaging study of the craniocervical junction in adolescent idiopathic scoliosis in upright posture

Gary Deutchman, Marc Lamantia, Scott Bender

Abstract

STUDY DESIGN:

Conventional and phase-contrast magnetic resonance (MR) imaging performed in a upright Fonar Scanner used to evaluate the flow dynamics of cerebrospinal fluid (CSF) flow dynamics at craniocervical junction in adolescent idiopathic scoliosis (AIS).

OBJECTIVES:

To determine if patients previously diagnosed with AIS have normometric dynamic flow of CSF at the craniocervical junction verses normal controls and the correlation with Electronystagmography evaluation for ocular nystagmus.

SUMMARY OF BACKGROUND DATA:

Studies in the published literature have shown patients with Arnold Chiari Malformation have obstructed CSF flow. Although not all patients with AIS have been shown to have ACM, studies have confirmed a higher incidence of Low-lying cerebellar tonsils and syringomyelia in this population. Furthermore, studies have documented CSF flow disturbance in AIS patients when studied in the recumbent position.  We will investigate whether disturbed CSF flow is more evident in AIS subjects at the foramen magnum level in the upright posture, as well as identify if the level of the cerebellar tonsils correlates with CSF disturbance.

METHODS:

Conventional and phase-contrast MR will be performed in 55 adolescent girls (40 AIS subjects and 15 age-matched controls). Measurements of cerebellar tonsillar level related to the basion-opsithion (BO) line, and peak velocity of CSF flow in both the anterior and posterior subarachnoid space through foramen magnum are to be measured. Correlations to findings of vestibulocerebellar dysfunction can uncover associated functional deficits.

RESULTS:

In a previous study with patients evaluated in the recumbent position, a total of 42% of subjects in the AIS group had the cerebellar tonsillar tip positioned 1 mm below the BO line. The cerebellar tonsillar level in AIS subjects was significantly lower than the median tonsillar level in normal controls (P < 0.01). However, the peak CSF velocities through foramen magnum showed no significant difference (P > 0.05). We propose studying these parameters with the patient in the upright posture.

Cost to do study

55 MRI Studies with CSF Flow Analysis x $1500=  $82,500

55 ENG studies x $400 = $22000

Research assistants (2) = $20,000

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Total needed for study = $124,500