Abstract：
BACKGROUND: Little is known about the prevalence of intraspinal pathology in children who toe walk, but magnetic resonance imaging (MRI) may be part of the diagnostic workup. The purpose of this study was to examine the role of MRI for children who toe walk with a focus on the rate of positive findings and associated neurosurgical interventions performed for children with said MRI findings.
METHODS: A single-center tertiary hospital database was queried to identify a cohort of 118 subjects with a diagnosis of toe walking who underwent spinal MRI during a 5-year period. Patient and MRI characteristics were summarized and compared between subjects with a major abnormality, minor abnormality, or no abnormality on MRI using multivariable logistic regression. Major MRI abnormalities included those with a clear spinal etiology, such as fatty filum, tethered cord, syrinx, and Chiari malformation, while minor abnormalities had unclear associations with toe walking.
RESULTS: The most common primary indications for MRI were failure to improve with conservative treatment, severe contracture, and abnormal reflexes. The prevalence of major MRI abnormalities was 25% (30/118), minor MRI abnormalities was 19% (22/118), and normal MRI was 56% (66/118). Patients with delayed onset of toe walking were significantly more likely to have a major abnormality on MRI ( P =0.009). The presence of abnormal reflexes, severe contracture, back pain, bladder incontinence, and failure to improve with conservative treatment were not significantly associated with an increased likelihood of major abnormality on MRI. Twenty-nine (25%) subjects underwent tendon lengthening, and 5 (4%) underwent neurosurgical intervention, the most frequent of which was detethering and sectioning of fatty filum.
CONCLUSIONS: Spinal MRI in patients who toe walk has a high rate of major positive findings, some of which require neurosurgical intervention. The most significant predictor of intraspinal pathology was the late onset of toe walking after the child had initiated walking. MRI of the spine should be considered by pediatric orthopedic surgeons in patients with toe walking who present late with an abnormal clinical course.
METHODS: Level III Retrospective Comparative Study.
METHODS: A single-center tertiary hospital database was queried to identify a cohort of 118 subjects with a diagnosis of toe walking who underwent spinal MRI during a 5-year period. Patient and MRI characteristics were summarized and compared between subjects with a major abnormality, minor abnormality, or no abnormality on MRI using multivariable logistic regression. Major MRI abnormalities included those with a clear spinal etiology, such as fatty filum, tethered cord, syrinx, and Chiari malformation, while minor abnormalities had unclear associations with toe walking.
RESULTS: The most common primary indications for MRI were failure to improve with conservative treatment, severe contracture, and abnormal reflexes. The prevalence of major MRI abnormalities was 25% (30/118), minor MRI abnormalities was 19% (22/118), and normal MRI was 56% (66/118). Patients with delayed onset of toe walking were significantly more likely to have a major abnormality on MRI ( P =0.009). The presence of abnormal reflexes, severe contracture, back pain, bladder incontinence, and failure to improve with conservative treatment were not significantly associated with an increased likelihood of major abnormality on MRI. Twenty-nine (25%) subjects underwent tendon lengthening, and 5 (4%) underwent neurosurgical intervention, the most frequent of which was detethering and sectioning of fatty filum.
CONCLUSIONS: Spinal MRI in patients who toe walk has a high rate of major positive findings, some of which require neurosurgical intervention. The most significant predictor of intraspinal pathology was the late onset of toe walking after the child had initiated walking. MRI of the spine should be considered by pediatric orthopedic surgeons in patients with toe walking who present late with an abnormal clinical course.
METHODS: Level III Retrospective Comparative Study.
摘要：
背景：关于脚趾行走儿童的脊柱内病变的患病率知之甚少，但磁共振成像（MRI）可能是诊断检查的一部分。这项研究的目的是检查MRI对脚趾行走儿童的作用，重点是阳性发现率和对具有所述MRI发现的儿童进行的相关神经外科干预。
方法：查询了一个单中心三级医院数据库，以确定一组118名诊断为脚趾行走的受试者，他们在5年内接受了脊柱MRI检查。总结患者和MRI特征，并在有重大异常的受试者之间进行比较，轻微异常,或使用多变量逻辑回归的MRI没有异常。主要的MRI异常包括那些有明确的脊柱病因，如脂肪丝，系绳,syrinx,和Chiari畸形,而轻微的异常与脚趾行走有不清楚的关联。
结果：MRI最常见的主要适应症是保守治疗未能改善，重度挛缩,和异常的反射。主要MRI异常的患病率为25％（30/118），轻微的MRI异常为19%（22/118），正常MRI为56%(66/118)。脚趾行走延迟发作的患者更有可能在MRI上出现重大异常（P=0.009）。异常反射的存在，重度挛缩,背痛,膀胱尿失禁,保守治疗未能改善与MRI出现重大异常的可能性增加无关.29名（25％）受试者接受了肌腱延长，5人（4%）接受了神经外科手术，其中最常见的是脂肪丝的分离和切片。
结论：在脚趾行走的患者中，脊柱MRI具有较高的主要阳性发现率，其中一些需要神经外科手术。脊柱内病理学的最重要预测因素是儿童开始步行后脚趾步行的迟发。对于出现异常临床病程较晚的脚趾行走患者，小儿骨科医师应考虑脊柱MRI。
方法：III级回顾性对比研究。
方法：查询了一个单中心三级医院数据库，以确定一组118名诊断为脚趾行走的受试者，他们在5年内接受了脊柱MRI检查。总结患者和MRI特征，并在有重大异常的受试者之间进行比较，轻微异常,或使用多变量逻辑回归的MRI没有异常。主要的MRI异常包括那些有明确的脊柱病因，如脂肪丝，系绳,syrinx,和Chiari畸形,而轻微的异常与脚趾行走有不清楚的关联。
结果：MRI最常见的主要适应症是保守治疗未能改善，重度挛缩,和异常的反射。主要MRI异常的患病率为25％（30/118），轻微的MRI异常为19%（22/118），正常MRI为56%(66/118)。脚趾行走延迟发作的患者更有可能在MRI上出现重大异常（P=0.009）。异常反射的存在，重度挛缩,背痛,膀胱尿失禁,保守治疗未能改善与MRI出现重大异常的可能性增加无关.29名（25％）受试者接受了肌腱延长，5人（4%）接受了神经外科手术，其中最常见的是脂肪丝的分离和切片。
结论：在脚趾行走的患者中，脊柱MRI具有较高的主要阳性发现率，其中一些需要神经外科手术。脊柱内病理学的最重要预测因素是儿童开始步行后脚趾步行的迟发。对于出现异常临床病程较晚的脚趾行走患者，小儿骨科医师应考虑脊柱MRI。
方法：III级回顾性对比研究。
