Pediatric intramedullary spinal cord tumor outcomes using the WeeFIM scale.

PURPOSE: The Functional Independence Measure for children (WeeFIM) is a user-friendly functional outcomes tool that has been validated across other traditional functional scales. Historically, the significant neurologic and functional deficits of intramedullary spinal cord tumors (IMSCTs) have been monitored by coarse or overbearing functional outcomes tools that make it difficult to measure the slow improvement/decline seen in these patients. This study is the first to report WeeFIM outcomes on a series of IMSCTs with emphasis on an aggressive surgical strategy. METHODS: A retrospective review from 2005 to 2014 was performed for nine patients who underwent resective surgery for intramedullary spinal cord tumors with intraoperative ultrasound and neurophysiologic monitoring. WeeFIM scales were assessed at admission and discharge to evaluate changes in severity of disability and need for assistance. RESULTS: At the time of this submission, 7/9 patients are alive. The mean WeeFIM improvement was 27 points (8-50 points) with a mean WeeFIM efficiency of 2.0 points/day. CONCLUSIONS: The WeeFIM scale is an appropriate and useful scale for measuring postoperative improvements in patients with IMSCTs undergoing aggressive resective surgery. Attention to intraoperative spinal cord monitoring and prevention of spinal column instability may prevent morbidity related to surgery, and functional outcomes do not appear to be compromised by an aggressive surgical approach.

Scoliosis rates in symptomatic patients as demonstrated with weight-bearing or supine MR imaging.

CONTEXT: In the United States an estimated 6 million persons are affected by scoliosis, which is characterized by a 3-dimensional deformity of the spine that involves a curvature in the sagittal, frontal, and transverse planes. OBJECTIVE: To determine the rates of scoliosis in patients with spine-related pain unassociated with cancer, as demonstrated by magnetic resonance (MR) images obtained with patients in either a weight-bearing or a supine position. METHODS: The authors conducted a retrospective review of MR images obtained during a 2-year period in patients referred because of symptoms of radiculopathy or other spine-related pain unassociated with cancer and unresolved after conservative treatment. Images were obtained either with the patient supine or with the patient in a weight-bearing, seated position, and all images were reviewed by a neuroimaging physician. Scoliosis was assessed according to the Cobb angle method. RESULTS: A total of 1982 MR images from 1486 patients were reviewed. Of those, 986 images in 761 patients were obtained with a low-field-strength (0.3-T) MR imager with the patient supine, and 996 images in 725 patients were obtained with a mid-field-strength (0.6-T) MR imager with the patient in a weight-bearing, seated position. Scoliosis (dextroscoliosis, levoscoliosis, or both) was identified in 958 MR images (48.3%), of which 779 (78.2%) were obtained with patients in a weight-bearing position and 179 (18.2%) were obtained with patients in a supine position. CONCLUSION: The scoliosis rate was lower in the supine MR imaging group than in the weight-bearing MR imaging group. Scoliosis rates may be affected by the position in which the patient is examined, with the possibility that the weight-bearing position differentially exposes scoliosis, compared with the supine position.