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Topic:

Toe Walking

Issue:

Ankle

Category:

Developmental

Title:

MRI of the Spine in Patients who Toe Walk: Is There a Role?

Author:

Flaugh, Rachel A. BS; May, Collin J. MD, MPH; Curran, Patrick MD; Miller, Patricia E. MS; Kasser, James R. MD; Shore, Benjamin J. MD, MPH

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p 267-272, DOI: 10.1097/BPO.0000000000002633

Level Of Evidence:

III

# of Patients:

118

Study Type:

Retrospective cohort study

Location:

Single tertiary hospital

Summary:

Investigates the prevalence of intraspinal pathology in children who toe walk and evaluates the utility of spinal MRI in identifying such conditions. Examines the rate of positive MRI findings and neurosurgical interventions among patients.

Methods:

Data collected from a tertiary hospital database over five years. Patients grouped based on MRI findings into major abnormalities, minor abnormalities, or normal. Major abnormalities included fatty filum, tethered cord, syrinx, and Chiari malformation; minor abnormalities had unclear relevance to toe walking. Multivariable logistic regression was used to identify predictors of MRI findings.

Exclusions:

Not specified

Results:

MRI Findings: Major abnormalities: 25% (30/118) Minor abnormalities: 19% (22/118) Normal MRI: 56% (66/118) Delayed onset of toe walking significantly predicted major MRI abnormalities (P=0.009). No significant association found between MRI abnormalities and abnormal reflexes, severe contractures, back pain, bladder incontinence, or failure of conservative treatment. Surgical interventions: 25% (29/118) underwent tendon lengthening. 4% (5/118) required neurosurgical intervention, such as detethering or sectioning of fatty filum.

Conclusions:

Spinal MRI has a high rate of major positive findings in patients who toe walk, particularly in those with late-onset toe walking. MRI should be considered in pediatric toe walkers presenting with atypical clinical courses, as it may reveal pathologies requiring neurosurgical management.

Relevance:

Limitations:

Perspective:

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