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Ndongo Sonfack DJ, Bergeron D, Wang Z, Boubez G, Shedid D, Yuh SJ. Surgical management of high-grade lumbar spondylolisthesis associated with Hajdu-Cheney syndrome: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22171. [PMID: 36088555 PMCID: PMC9706325 DOI: 10.3171/case22171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hajdu-Cheney syndrome (HCS) is a rare connective tissue disorder characterized by severe bone demineralization. In the spine, it is associated with the early onset of severe osteoporosis and can cause spondylolisthesis. Spinal instrumentation in the setting of severe osteoporosis is challenging because of poor resistance of vertebrae to biomechanical stress. OBSERVATIONS A 59-year-old woman with known idiopathic HCS presented with a grade 4 L5-S1 spondylolisthesis and right L5 pedicle fracture associated with a left L5 pars fracture, causing a progressive L5 radiculopathy that was worse on the left side than the right side and bilateral foot drop. The authors performed decompressive lumbar surgery, which included a complete L5 laminectomy and resection of the left L5 pedicle. This was followed by multilevel lumbosacral instrumentation using cement-augmented fenestrated pedicle screws as well as transdiscal sacral screws and bilateral alar-iliac fixation. Postoperatively, the radicular pain resolved, and the left foot drop partially recovered. LESSONS Stabilization of high-grade spondylolisthesis in the setting of bone demineralization disorders is challenging. The use of different instrumentation techniques is important because it increases biomechanical stability of the overall instrumentation construct.
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Affiliation(s)
| | | | - Zhi Wang
- Orthopedics, University of Montréal Hospital Center, Montréal, Québec, Canada
| | - Ghassan Boubez
- Orthopedics, University of Montréal Hospital Center, Montréal, Québec, Canada
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Ahmed S, Arif A, Abbas S, Khan MO, Kirmani S, Khan AH. Hajdu Cheney Syndrome due to NOTCH2 defect - First case report from Pakistan and review of literature. Ann Med Surg (Lond) 2021; 62:154-159. [PMID: 33520214 PMCID: PMC7820303 DOI: 10.1016/j.amsu.2021.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Hajdu Cheney Syndrome (HCS) is a rare skeletal disease characterized by severe, progressive focal bone loss with osteoporosis, variable craniofacial, vertebral anomalies and distinctive facial features. It is inherited as an autosomal dominant disease although sporadic cases have been described in literature. Identifying these cases in clinical practice is important for proper diagnosis and management. CASE PRESENTATION We report a case of a 36-year-old male patient presented at metabolic bone disease clinic at the Aga Khan University Hospital with history of multiple fragility fractures and juvenile osteoporosis since childhood. DNA sequence analysis of the NOTCH2 coding sequence revealed a pathogenic variant in NOTCH 2, Exon 34, c.6426_6427insTT (p.Glu2143Leufs*5), consistent with a NOTCH2 related conditions including HCS. CLINICAL DISCUSSION The multitude of presentations associated with HCS are linked to the NOTCH2 gene, as Notch signaling is one of the core signaling pathways that control embryonic development. Hence, mutations in the Notch signaling pathway cause developmental phenotypes that affect various organs including the liver, skeleton, heart, eye, face, kidney, and vasculature. CONCLUSION To the best of our knowledge, nucleotide mutations of c.6933delT, c.6854delA, c.6787C.T, and c.6424-6427delTCTG were all determined to be novel, with c.6428T > C being the most common mutation found in literature. The c.6426_6427insTT mutation our patient was found to have via gene sequencing too appears to be a novel mutation, which has not previously been reported in literature.
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Affiliation(s)
- Sibtain Ahmed
- Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aahan Arif
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Saadia Abbas
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Osama Khan
- Medical College, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salman Kirmani
- Department of Paediatrics & Child Health, Aga Khan University. Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aysha Habib Khan
- Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Lambert JC, Baudart P, De Sandre-Giovannoli A, Molin A, Marcelli C. Lamin A/C gene (LMNA) mutation associated with laminopathy: A rare cause of idiopathic acro-osteolysis. Joint Bone Spine 2018; 86:525-527. [PMID: 30528549 DOI: 10.1016/j.jbspin.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | - Pauline Baudart
- CHU de Caen, department of rheumatology, avenue de la Côte de Nacre, Caen, 14000, France
| | - Annachiara De Sandre-Giovannoli
- AP-HM, department of medical genetics, La Timone Children's hospital, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Arnaud Molin
- CHU de Caen, department of genetics, avenue de la Cote de Nacre, Caen, 14000, France
| | - Christian Marcelli
- CHU de Caen, department of rheumatology, avenue de la Côte de Nacre, Caen, 14000, France; Université Caen Normandie, medical School, Caen, 14000, France
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Akbar L, Akbar N, Al Muhaish M, Akbar S, Kamar A. Acroosteolysis in Systemic Sclerosis. Am J Med Sci 2018; 357:e5-e6. [PMID: 30454843 DOI: 10.1016/j.amjms.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Lujayn Akbar
- Department of Pediatrics and Department of Family Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Nuralhuda Akbar
- Department of Medicine, Dammam Medical Complex, Dammam, Saudi Arabia.
| | - Mona Al Muhaish
- Department of Pediatrics and Department of Family Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Shahrazad Akbar
- Department of Pediatrics and Department of Family Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Atef Kamar
- Department of Medicine, Dammam Medical Complex, Dammam, Saudi Arabia
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Sakka S, Gafni RI, Davies JH, Clarke B, Tebben P, Samuels M, Saraff V, Klaushofer K, Fratzl-Zelman N, Roschger P, Rauch F, Högler W. Bone Structural Characteristics and Response to Bisphosphonate Treatment in Children With Hajdu-Cheney Syndrome. J Clin Endocrinol Metab 2017; 102:4163-4172. [PMID: 28938420 PMCID: PMC5673271 DOI: 10.1210/jc.2017-01102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Hajdu-Cheney syndrome (HJCYS) is a rare, multisystem bone disease caused by heterozygous mutations in the NOTCH2 gene. Histomorphometric and bone ultrastructural analyses in children have not been reported and sparse evidence exists on response to bisphosphonate (BP) therapy. OBJECTIVE To investigate clinical and bone histomorphometric characteristics, bone matrix mineralization, and the response of bone geometry and density to BP therapy. PATIENTS Five children with HJCYS (three males) between 6.7 and 15.3 years of age. INTERVENTIONS Various BP regimens (pamidronate, zoledronic acid, and alendronate) were used for between 1 and 10 years. MAIN OUTCOME MEASURES Pretreatment transiliac bone biopsy specimens and peripheral quantitative computed tomography results were available in four and three subjects, respectively. Bone histomorphometry and quantitative backscattered electron imaging were performed in two patients. The response to BP was monitored using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. RESULTS Three patients had previously unreported NOTCH2 mutations. Histomorphometry demonstrated increased bone resorption and osteoclast numbers, increased heterogeneity of mineralization, and immature, woven bone. Trabecular bone formation was normal or elevated. Radius cortical thickness and density and lumbar spine bone mineral density were reduced at baseline and increased in response to BP therapy, which was not sustained after therapy discontinuation. CONCLUSIONS Increased bone resorption and low cortical thickness are consistent with the effect of activating NOTCH2 mutations, which stimulate osteoclastogenesis. The increase in lumbar spine bone density and radial cortical thickness and density by BP therapy provides evidence of beneficial treatment effects in children with HJCYS.
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Affiliation(s)
- Sophia Sakka
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - Rachel I. Gafni
- Section on Skeletal Disorders and Mineral Homeostasis, NIDCR, National Institutes of Health, Bethesda, Maryland 20892
| | - Justin H. Davies
- Department of Endocrinology, Southampton Children's Hospital, Southampton SO16 6YD, United Kingdom
| | - Bart Clarke
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Peter Tebben
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Mark Samuels
- Centre de Recherché du Centre Hospitalier Universitaire Ste‐Justine, Université de Montréal, Montreal H3T 1C5, Canada
- Department of Medicine, Université de Montréal, Montreal H3C 3J7, Canada
| | - Vrinda Saraff
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK, 1140 Vienna, Austria
- AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, 1120 Vienna, Austria
| | - Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK, 1140 Vienna, Austria
- AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, 1120 Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK, 1140 Vienna, Austria
- AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, 1120 Vienna, Austria
| | - Frank Rauch
- Shriners Hospital for Children and McGill University, Montreal, Quebec H4A 0A9, Canada
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
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