Spine iSAWE 20

Question

A 14 year old girl has a left thoracic scoliosis of 30 degrees. Her abdominal reflexes are absent on one side.

Spine iSAWE 20, sagittal MRI of the cervical spine
Sagittal MRI of the cervical spine. Image by Cyborg Ninja at English Wikipedia, derivative work by SUM1, Wikimedia Commons, CC BY 4.0.
  1. What does the MRI show and why was it requested?
  2. What features of a scoliosis suggest an underlying cause?
  3. How does this change management?

Answer

MRI

  • Fluid filled cavity in the cervical spinal cord (syrinx)
  • Often associated with Chiari I malformation
  • Left thoracic curve and an abnormal abdominal reflex triggered the MRI

Atypical features

  • Left thoracic curve
  • Abnormal neurology, asymmetric abdominal reflexes, clonus, cavus foot
  • Pain
  • Rapid progression
  • Onset before age 10 (juvenile or infantile)
  • Short sharp curve or apical kyphosis
  • Skin markers such as hairy patch or cafĂ© au lait spots

Management

  • Neurosurgical referral
  • Chiari decompression, curve may stabilise or improve in younger children
  • Bracing for moderate curves
  • Fusion for progressive curves, with neuromonitoring
  • Higher risk of neurological injury during correction if the syrinx is untreated

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.