Assessing pedicle morphology in pediatric spinal deformity: can magnetic resonance imaging match computed tomography? A systematic review.

BACKGROUND

Pediatric spinal deformities frequently require surgical correction, and precise preoperative planning is essential to ensure optimal outcomes and minimize complications. A key aspect of planning involves assessing pedicle morphology to determine appropriate screw sizing. This systematic review examines whether magnetic resonance imaging (MRI) can serve as a reliable, radiation-free alternative to computed tomography (CT). While MRI shows promising potential, current evidence presents mixed results regarding its accuracy and clinical applicability compared to CT.

METHODS

Following PRISMA guidelines, a systematic review was performed. Literature from Medline, Scopus, Embase, and the Cochrane Library, up to August 2025, was analyzed. Search terms included "scoliosis," "pediatric deformity," "pedicle morphology," "pedicle dimension," "magnetic resonance imaging," and "computed tomography." The extracted data included study details, patient demographics, scoliosis etiology, radiographic techniques, pedicle measurement methods, and outcomes of MRI-CT comparison. Risk of bias was assessed using the MINORS tool.

RESULTS

Of 319 identified studies, 6 met the inclusion criteria (n = 428 patients). A total of 12,633 pedicles were analyzed across the studies, with MRI and CT used for preoperative assessment. MRI showed good concordance with CT for most measurements though accuracy decreased for more severe pedicle abnormalities. MRI was generally reliable for preoperative planning but had limitations, especially for pedicle sizing.

CONCLUSION

While MRI offers a radiation-free alternative for preoperative assessment of pedicle morphology in pediatric spinal deformity surgery, current evidence is limited to retrospective studies and shows variable accuracy, particularly in severe or complex cases. CT generally remains more reliable for precise pedicle evaluation and continues to represent the standard of care. Future advancements in MRI technology may help improve its accuracy and expand its role in clinical practice, but stronger prospective evidence is needed before it can be considered a full substitute for CT.