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Zarei M, Moosavi M, Rahimi NO, Rostami M. Surgical Management of Pediatric Cervical Angular Kyphosis with 540° Approach and Metacarpal Plate: A Case Report and Introduction of a Novel Technique. Asian J Neurosurg 2021; 16:155-158. [PMID: 34211885 PMCID: PMC8202397 DOI: 10.4103/ajns.ajns_195_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/23/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
Surgical decompression, deformity correction, and instrumentation of the upper cervical spine are challenging problems in cervical kyphosis, especially in infants and pediatrics. According to patients' age, surgical exposure is difficult and selecting the appropriate instrument for rigid fixation is crucial. In this article, we present a case of 2 years old with cervical angular kyphosis, which was approached posteriorly at first. Through posterior approach, C3–C5 laminectomy with complete excision of spinous process was performed. Then, the patient's position was changed to supine and C3–C5 corpectomies were performed anteriorly with a longitudinal incision, and the thecal sac was decompressed. A titanium cage with appropriate size and graft was placed after possible deformity correction conducted with head traction and neck extension. Anterior fixation was performed with two, 2-mm T-shaped metacarpal plates with two screws in C2 and four screws in C6. The patient's position was changed to prone again, and posterior fixation was done with two metacarpal plates located on lateral masses. We showed that a novel technique in correction and fixation of cervical kyphosis in pediatric is using metacarpal plates while they are fixed to lateral masses.
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Affiliation(s)
- Mohammad Zarei
- Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Ostad Rahimi
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Singh S, Sardhara J, Raiyani V, Saxena D, Kumar A, Bhaisora KS, Das KK, Mehrotra A, Srivastava AK, Behari S. Craniovertebral junction instability in Larsen syndrome: An institutional series and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:276-286. [PMID: 33824557 PMCID: PMC8019120 DOI: 10.4103/jcvjs.jcvjs_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Larsen syndrome (LS) is characterized by osteo-chondrodysplasia, multiple joint dislocations, and craniofacial abnormalities. Symptomatic myelopathy is attributed to C1-C2 instability and sub-axial cervical kyphosis. In this article, we have analyzed the surgical outcome after posterior fixation in LS with craniovertebral junction instability. Methods Ten symptomatic pediatric patients, operated between 2011 and 2019, were included, and the clinical outcome was assessed by Nurick grade, neurological improvement, and complications. The requirement of anti-spasticity drugs, the degree of bony fusion, and restriction of neck movement were also noted. At last follow-up, patient satisfaction score (PSS) and back to school status were studied. We also reviewed the literature and categorized two types of presentation of reported LS patients and discussed the pattern of disease progression among both. Results Ten patients, age range 1.5-16 years, underwent 12 surgeries (6 C1-C2 fixation, 4 long-segment posterior cervical fixation, and 2 trans-oral decompressions as the second stage); the mean follow-up was 23 (range, 6-86 months). All the ten patients in our study had the characteristic "dish-" like face and nine patients had acral anomalies. The median Nurick grade improved from preoperative (median = 4) to follow-up (median = 3). The requirement of anti-spasticity drugs decreased in seven patients and the neck-pain improved in nine patients. The median satisfaction at follow-up was good (median PSS = 2); five patients were going back to school. Conclusion Craniovertebral junction instability in LS is rare and surgically challenging. Early posterior fixation showed a promising outcome with a halt in the disease progression.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vandan Raiyani
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepti Saxena
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Deora H, Singh S, Sardhara J, Behari S. A 360-Degree Surgical Approach for Correction of Cervical Kyphosis and Atlantoaxial Dislocation in the Case of Larsen Syndrome. J Neurosci Rural Pract 2020; 11:196-201. [PMID: 32140028 PMCID: PMC7055606 DOI: 10.1055/s-0039-3402624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Larsen syndrome is chronic debilitating disease that presents with multiple joint dislocations and severely affects the cervical spine in the form of cervical kyphosis and atlantoaxial dislocation. Children usually present in early with a myriad of deficits, compressive myelopathy being the most common. In addition to a bony compression, there is sometimes a soft tissue component, which is seldom addressed. We present here a case of atlantoaxial dislocation with cervical kyphosis due to Larsen syndrome, and along with our previous experience on syndromic atlantoaxial dislocations, we try to define an algorithm for the treatment approach of these onerous challenges. The importance of early intervention is also emphasized with a literature review of similar cases. In addition to the obvious physical damage, early intervention can also avoid the more sinister socioeconomic face of this debilitating disease.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Wagner MW, Poretti A, Benson JE, Huisman TAGM. Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review. J Neuroimaging 2016; 27:162-209. [PMID: 28000960 DOI: 10.1111/jon.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed. Sensitive and specific identification of CNS lesions while evaluating a child with a GSD requires a detailed knowledge of the possible associated CNS abnormalities. Here, we provide a pattern-recognition approach for neuroimaging findings in GSDs guided by the obvious skeletal manifestations of GSD. In particular, we summarize which CNS findings should be ruled out with each GSD. The diseases (n = 180) are classified based on the skeletal involvement (1. abnormal metaphysis or epiphysis, 2. abnormal size/number of bones, 3. abnormal shape of bones and joints, and 4. abnormal dynamic or structural changes). For each disease, skeletal involvement was defined in accordance with Online Mendelian Inheritance in Man. Morphological CNS involvement has been described based on extensive literature search. Selected examples will be shown based on prevalence of the diseases and significance of the CNS involvement. CNS involvement is common in GSDs. A wide spectrum of morphological abnormalities is associated with GSDs. Early diagnosis of CNS involvement is important in the management of children with GSDs. This pattern-recognition approach aims to assist and guide physicians in the diagnostic work-up of CNS involvement in children with GSDs and their management.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane E Benson
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Jasiewicz B, Potaczek T, Duda S, Tęsiorowski M. Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:216-8. [PMID: 26692703 PMCID: PMC4660502 DOI: 10.4103/0974-8237.167886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Cervical kyphosis in diastrophic dysplasia (DTD) is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results.
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Affiliation(s)
- Barbara Jasiewicz
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Jagiellonian University, Zakopane, Poland
| | - Tomasz Potaczek
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Jagiellonian University, Zakopane, Poland
| | - Sławomir Duda
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Jagiellonian University, Zakopane, Poland
| | - Maciej Tęsiorowski
- Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Jagiellonian University, Zakopane, Poland
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Hervey-Jumper SL, Garton HJL, Wetjen NM, Maher CO. Neurosurgical management of congenital malformations and inherited disease of the spine. Neuroimaging Clin N Am 2011; 21:719-31, ix. [PMID: 21807320 DOI: 10.1016/j.nic.2011.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Congenital malformations encompass a diverse group of disorders present at birth as result of genetic abnormalities, infection, errors of morphogenesis, or abnormalities in the intrauterine environment. Congenital disorders affecting the brain and spinal cord are often diagnosed before delivery with the use of prenatal ultrasonography and maternal serum screening. Over the past several decades there have been major advances in the understanding and management of these conditions. This article focuses on the most common spinal congenital malformations.
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Distinctive tomographic features of atlantoaxial dislocation in a boy with acromesomelic dysplasia du Pan syndrome. Clin Dysmorphol 2009; 18:122-126. [PMID: 19449465 DOI: 10.1097/mcd.0b013e32832955a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distinctive tomographic features of atlantoaxial dislocation have been encountered in a child with du Pan syndrome. Three-dimensional computed tomography scan showed agenesis of the odontoid process associated with significant hypoplasia of the left lateral mass of the odontoid. Bidirectional fluorescent DNA sequencing have been used to identify mutations in the complete coding region (exon 1-2) of the cartilage-derived morphogenic protein 1 gene. No mutation was detected in the analysed region. We report what might be a novel variant of acromesomelic du Pan syndrome.
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Madera M, Crawford A, Mangano FT. Management of severe cervical kyphosis in a patient with Larsen syndrome. Case report. J Neurosurg Pediatr 2008; 1:320-4. [PMID: 18377309 DOI: 10.3171/ped/2008/1/4/320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Larsen syndrome is a rare genetic disorder of the connective tissue that is characterized by multiple joint dislocations, distinctive deformities of the hands and feet, characteristic facial features, kyphoscoliosis, and segmentation anomalies of the vertebrae. Diverse treatment options, including conservative observation and surgical correction, have been reported for patients who present with cervical spine pathophysiology. Differences in surgical approaches, timing of the correction, and pre- or postoperative bracing have been reported. According to the authors, the present case is the first report of a pediatric patient with Larsen syndrome in whom an asymptomatic cervical instability was treated before neurological deterioration with synchronous anterior decompression and fixation, posterior fusion and fixation, and halo placement. A review of the literature on similar patients reveals the variety of practices associated with a diagnosis of Larsen syndrome.
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Affiliation(s)
- Marci Madera
- Department of Neurosurgery, University of Cincinnati College of Medicine Surgery, Cincinnati, Ohio, USA
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Abstract
Skeletal dysplasias are a heterogeneous group of disorders in which there is abnormal cartilage and bone formation, growth, and remodeling. There are more than 200 described skeletal dysplasias. Skeletal dysplasias can affect the spine in various ways, with attendant neurosurgical implications for diagnosis and treatment. Craniocervical junction abnormalities, atlantoaxial subluxation, and kyphoscoliotic deformity are among the common spinal problems that are found in certain skeletal dysplasias.
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Affiliation(s)
- Debbie Song
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109-0338, USA
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Sakaura H, Matsuoka T, Iwasaki M, Yonenobu K, Yoshikawa H. Surgical treatment of cervical kyphosis in Larsen syndrome: report of 3 cases and review of the literature. Spine (Phila Pa 1976) 2007; 32:E39-44. [PMID: 17202879 DOI: 10.1097/01.brs.0000250103.88392.8e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE To review the surgical results for midcervical kyphosis in 3 cases with Larsen syndrome, and to discuss the choice of surgical treatments. SUMMARY OF BACKGROUND DATA Cervical kyphosis is the most hazardous and serious manifestation of Larsen syndrome due to the risk of life-threatening paralysis, and thus usually requires surgical treatment. However, little information has been reported concerning surgical treatments for this challenging condition. METHODS Three patients with Larsen syndrome were surgically treated for midcervical kyphosis at our institution. RESULTS An infant with mild cervical kyphosis was successfully treated with posterior arthrodesis using a halo immobilization, and anterior vertebral growth with a mature posterior fusion mass resulted in spontaneous correction of the kyphosis. In the remaining 2 infants with myelopathic symptoms due to severe and structural kyphosis, anterior decompression and fusion via a lateral approach followed by posterior fusion with segmental spinal instrumentation and halo immobilization resulted in improved neurologic symptoms and solid fusion. CONCLUSIONS Posterior spinal fusion is only indicated for patients with mild and flexible cervical kyphosis, and anterior decompression and circumferential arthrodesis is required for patients with severe kyphotic deformity, who usually develop myelopathic symptoms. Anterior surgery for such a small patient with severe kyphosis involves much higher risk of spinal cord injury during decompression maneuvers and difficulty in stabilization of the reconstructed cervical spine. Therefore, all patients with Larsen syndrome should be screened with radiographs at the first visit to detect cervical kyphosis early so that posterior alone fusion is possible.
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Affiliation(s)
- Hironobu Sakaura
- Department of Orthopedics, Osaka University Graduate School of Medicine, Osaka, Japan.
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Katz DA, Hall JE, Emans JB. Cervical kyphosis associated with anteroposterior dissociation and quadriparesis in Larsen's syndrome. J Pediatr Orthop 2005; 25:429-33. [PMID: 15958889 DOI: 10.1097/01.bpo.0000161091.85350.54] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neither the natural history nor the optimal treatment of cervical spine anomalies in Larsen's syndrome has been clearly defined. The authors describe two patients with Larsen's syndrome with cervical kyphosis, anteroposterior dissociation, and quadriparesis to show the variable clinical progression and offer a description of the authors' treatment. One patient has had continued neurologic and radiographic improvement with nonoperative treatment consisting of early traction. The other patient was treated with posterior fusion that failed to halt progressive kyphosis of the anterior vertebral bodies because of anteroposterior dissociation. He then was treated by resection of the posterior fusion, traction, and anterior and posterior decompression and fusion. Cervical kyphosis in patients with Larsen's syndrome is unpredictable, and both nonoperative and operative treatments have the potential to be successful. Anteroposterior dissociation of the cervical spine may be more common in Larsen's syndrome than recognized previously and may profoundly affect operative strategy and outcome.
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Iwasaki M, Yamamoto T, Miyauchi A, Amano K, Yonenobu K. Cervical kyphosis: predictive factors for progression of kyphosis and myelopathy. Spine (Phila Pa 1976) 2002; 27:1419-25. [PMID: 12131739 DOI: 10.1097/00007632-200207010-00009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of 13 patients with cervical kyphosis. The authors propose new methods of measuring spinal cord compression and predicting the progression of kyphosis. OBJECTIVES To ascertain predictive factors for progression of cervical kyphosis and myelopathy. SUMMARY OF BACKGROUND DATA Cervical kyphosis may be congenital, result from decompression surgery, or occur as a posttraumatic deformity. Although there is the potential for progressive deformity and the development of myelopathy in all these situations, there are few previous reports of predictive factors for progression of cervical kyphosis and myelopathy in patients with cervical kyphosis. METHODS The authors studied radiographs and magnetic resonance imaging scans of 13 patients with cervical kyphosis, including 9 who had been operated on and had postsurgical secondary kyphosis, and 4 with idiopathic kyphosis without any of the above causes. Compression of the spinal cord at the apex of the cervical kyphosis was evaluated by magnetic resonance imaging of the ratio between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex. RESULTS The mean ratio between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex in five patients in whom myelopathy did not develop was 0.37, and was 0.21 in the patients in whom myelopathy developed. Progression of cervical kyphosis was associated with osteophyte formation at the anterior aspect of the vertebral body. CONCLUSION A ratio below 0.3 between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex was a risk factor for cervical myelopathy. One of the most predictable risk factors of progression of the cervical kyphosis was osteophyte formation at the anterior aspect of the vertebral body.
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Affiliation(s)
- Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
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Luk KDK, Yip DKH. Congenital anteroposterior spinal dissociation in Larsen's Syndrome: report on two operated cases with long-term follow-up. Spine (Phila Pa 1976) 2002; 27:E296-300. [PMID: 12065992 DOI: 10.1097/00007632-200206150-00023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The outcome of two patients with Larsen's syndrome after spinal surgery was evaluated after follow-up for 9 and 16 years. OBJECTIVE To report on a new phenomenon of anteroposterior dissociation of the vertebrae in Larsen's syndrome. To demonstrate that it can be visualized before surgery with imaging and also seen intraoperatively. To show that the neurologic recovery after surgery is sustained and to review the technical reasons for the difficulties in achieving a surgical fusion. The critical role of CT scanning will be illustrated. SUMMARY OF BACKGROUND DATA The results of preoperative and postoperative radiologic investigations and intraoperative findings are presented to support this new phenomenon. METHODS Two patients underwent multiple spinal surgeries because of a deteriorating myelopathic clinical status. Intraoperatively, anteroposterior dissociation was documented in both patients. There was great difficulty in obtaining a surgical fusion, and an unusually long circumferential fusion was eventually necessary to obtain stability. Prolonged halo-vest immobilization was essential. RESULTS Neurologic recovery was sustained over time, and the spinal deformity did not deteriorate. CONCLUSION Awareness of this phenomenon is essential to the management of spinal deformities in Larsen's syndrome when presenting with myelopathy. Special features in the radiologic workup should be sought after so as to plan staged surgical procedures. Conventional principles of planning of fusion levels are inadequate. Early treatment is advocated, as the neurologic compromise is reversible.
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Affiliation(s)
- Keith D K Luk
- Department of Orthopaedic Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Abstract
STUDY DESIGN Scoliosis in patients with diastrophic dysplasia was analyzed. OBJECTIVES To study the natural history of scoliosis and to classify the patients with different types of scoliosis. SUMMARY OF BACKGROUND DATA Typical findings in diastrophic dysplasia are short-limbed short stature, multiple joint contractures, early degeneration of joints, and spinal deformities. The largest studies have reported scoliosis in 37% to 88% of the patients with this rare skeletal dysplasia. The natural history of the deformity is unknown. METHODS Of the 130 unselected patients, 98 (75%) who were older than 16 years and/or had undergone surgery at the time of the last radiograph were included in the final analysis. These 98 patients included 37 males and 61 females. Their ages at the first radiograph ranged from newborn to 78 years (average, 21 years). The mean follow-up period was 20 years (range, 2-41 years) for 80 patients. Standard standing anteroposterior and lateral radiographs were taken. The degrees of scoliosis, kyphosis, and lordosis were measured according to the Cobb method. Classification of the scoliosis was based on the patient's age at onset of scoliosis, the rate of progression, the magnitude of the scoliosis at the end of growth, and the curve pattern. RESULTS Of the 98 patients in this study, 86 (88%) had scoliosis. This difference was highly significant statistically (P < 0.001), as compared with the normal population. The frequency of scoliosis was 90% among females and 84% among males. Scoliosis can be divided further into three subtypes: early progressive (11 patients), idiopathic-like (41 patients), and mild nonprogressive (33 patients). One patient had a congenital scoliosis. CONCLUSIONS Scoliosis is very common in patients with diastrophic dysplasia. The natural history of scoliosis varies from severe deformity with rapid progression to mild deformity without any progression. The authors suggest that the classification described in this report offers a tool for the predicting natural history of scoliosis in diastrophic dysplasia, and for adjusting the timing of surgery in individual patients.
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Affiliation(s)
- V Remes
- Hospital for Children's and Adolescents, Helsinki, Finland.
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Abstract
Severe thoracolumbar kyphosis in Larsen's syndrome is rare. A successful 10-year treatment course, including T2-L4 subfascial rod placement when the patient was 6 years 3 months of age, nine periodic lengthenings, and definitive surgery at age 14 years 4 months is presented. From preoperative to 2-year postoperative definitive surgery, the patient's T1 to S1 spine length increased from 19 to 36 cm. The patient's 83 degrees thoracolumbar kyphosis was transformed to 45 degrees kyphosis and 28 degrees lumbar lordosis, and scolioses of 95 degrees and 65 degrees were reduced to 64 degrees and 50 degrees.
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Affiliation(s)
- S K Neighbor
- University of Kansas Medical Center, Kansas City 66150-7387, USA
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Unsinn KM, Geley T, Freund MC, Gassner I. US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics 2000; 20:923-38. [PMID: 10903684 DOI: 10.1148/radiographics.20.4.g00jl06923] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography (US) of the spinal cord is performed in newborns with signs of spinal disease (cutaneous lesions of the back, deformities of the spinal column, neurologic disturbances, suspected spinal cord injury due to traumatic birth, and syndromes with associated spinal cord compression). The examination is performed with high-frequency linear- and curved-array transducers in the sagittal and axial planes from the craniocervical junction to the sacrum. Normal variants such as transient dilatation of the central canal and ventriculus terminalis can be demonstrated with US. US allows detection of congenital malformations, such as myelocele or myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, terminal myelocystocele, lateral meningocele, caudal regression syndrome, and hydromyelia or syringomyelia. Acquired intraspinal diseases following birth trauma and transient alterations after lumbar puncture can also be detected with US. US can demonstrate the entire spectrum of intraspinal anatomy and pathologic conditions with high geometric resolution. Therefore, US should be considered the initial imaging modality of choice for investigating the spinal cord in newborns.
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Affiliation(s)
- K M Unsinn
- Department of Pediatrics, Leopold-Franzen-University, Innsbruck, Austria.
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Abstract
STUDY DESIGN An evaluation of cervical kyphosis in diastrophic dysplasia from newborn to adult life. OBJECTIVES To discover the prevalence and natural history of cervical kyphosis in diastrophic dysplasia. SUMMARY OF BACKGROUND DATA Typical findings in this rare skeletal dysplasia are sport-limbed short stature, multiple joint contractures, early degeneration of joints, and spinal deformities such as cervical kyphosis, scoliosis, and exaggerated lumbar lordosis. In diastrophic dysplasia, spontaneous resolution of cervical kyphosis has been reported, but so have severe forms causing medullar compression leading to quadriplegia and death. The prevalence and clinical outcome of the kyphosis are not known. METHODS The radiographic natural history of the cervical spine was studied in 120 patients. They varied in age from newborns to 63-year-olds. The average follow-up time in 26 living patients with cervical kyphosis was 10.0 years. RESULTS Midcervical kyphosis was noted in 29 patients (24%) in their first radiograph. In 25 patients, the first radiographs were taken before the age of 18 months, and 24 of these patients (96%) had cervical kyphosis. The most severe case was that of a 32-year-old patient with a 165 degrees kyphosis. In the 24 patients, the kyphosis resolved spontaneously at an average age of 7.1 years. Three patients with a severe kyphosis died; one patient is alive. One patient, a 4-year-old child has mild resolving deformity. CONCLUSIONS Cervical kyphosis in diastrophic dysplasia usually is shown at the time of birth. It resolves spontaneously during growth and seldom needs treatment. Careful follow-up study and treatment, if necessary, are important tools for avoiding the neurologic problems and fatal outcome.
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Affiliation(s)
- V Remes
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland.
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