Childhood scoliosis revealing spinal cord tumors

Spinal cord tumors typically show slow and insidious growth and scoliosis may be the only presenting feature of these lesions. The aim of this study is to determine the clinical and/or imaging signs that can contribute in uncovering the underlying etiology of a presumed “idiopathic” scoliosis. We retrospectively reviewed seven cases of histologically confirmed spinal cord tumors presenting as scoliosis and diagnosed with MRI in our institution between 1996 and 2003. The children (six males and one female) were aged from 3 to 10 years. The scoliosis was associated with spinal pain and/or stiffness in all cases. Accurate neurological evaluation showed a motor deficit and/or mild neurological signs in all cases. Plain radiographs showed widening of the spinal canal in three patients. MRI allowed the diagnosis of spinal cord tumor in all patients. Associated syrinx was noted in five cases. Of which one child was presented with a “torticolis”, one with a localized thoraco–lumbar hyperkyphosis, three with left-sided thoracic curve and two with right-sided thoracic curve. All patients underwent surgical resection. Histological study concluded to astrocytomas (n=4), ependymoma (n=2) and epidermoïd cyst (n=1). Scoliosis should be considered as idiopathic only occult causes have been excluded. Neurological evaluation of these patients must be accurate. Early age of onset, male gender spinal pain and/or stiffness, left-sided curve, neurological signs, radiographic widening of the spinal canal are considered as atypical features and must lead to further investigation by MRI.