Brace treatment of thoracolumbar kyphosis in spondylometaphyseal dysplasia with restoration of vertebral morphology and sagittal profile: a case report

A novel sequence variant in COL10A1 causing spondylometaphyseal dysplasia accompanied with coxa valga: A case report

RATIONALE

Spondylometaphyseal dysplasia (SMD) is an extremely rare disorder of irregular development of spine and metaphyses of long tubular bones. Mutations in the collagen type X alpha 1 gene were found to underlie this condition. Previously reported mutations in the N-terminal non-collagenous NC2 domain and C-terminal non-collagenous NC1 domain failed to be identified in some specific patients.

PATIENT CONCERNS

A 23-year-old male was referred to us for fixed, angular thoracolumbar kyphosis with semi-paralysis, numbness, and tremor on his left lower limb. Marked hypoplasia of thoracolumbar vertebra and spinal canal stenosis were observed on radiology.

DIAGNOSES

He was diagnosed with spondylometaphyseal dysplasia (Type A4). Gene sequencing was performed using normalized targeted regions sequencing (TRS). A novel heterozygous missense variant p.Gly139Cys in the triple-helical region. Multiple lines of evidence imply this mutation to be pathogenic.

INTERVENTIONS

Posterior instrumentation and vertebral column resection were given to correct his fixed, angular thoracolumbar kyphosis.

OUTCOMES

The correction was satisfying and the functional outcomes were good.

LESSONS SUBSECTIONS AS PER STYLE

The findings corroborated that type X collagen plays a critical role in the formation of the human spine as well as the long bones, and further expanded the range of type X collagenopathy. Surgical procedure could be considered for patients with severe malformation and neurological impairments.

Surgical Orthopedics in a Spondylometaphyseal Dysplastic Patient

BACKGROUND

Spondylometaphyseal dysplasia (SMD) is a rare disease characterized by vertebral and metaphyseal abnormalities. The treatment of SMD spinal deformities remains a challenge for spinal surgeons. The purpose of this study is to demonstrate the feasibility and effectiveness of vertebral column resection of SMD by thoracolumbar kyphosis and scoliosis.

CASE DESCRIPTION

A 23-year-old man with SMD was referred to us with multivertebral anomalies and scoliosis, and a rigid curved thoracolumbar kyphosis in T11-12. The patient had fixed thoracolumbar kyphosis and scoliosis with neurologic symptoms. The morphology of vertebra was measured and calculated based on radiologic data. A 3-dimensional printing was made to help the spinal orthopedics. The anterior fusion was made with cages reconstruction and posterolateral fusion with screw fixation.

CONCLUSIONS

The spinal axes were corrected with obvious and satisfying realignment effects. The neurologic symptoms disappeared after surgery. The 1-year follow-up period was uneventful. Surgical treatment for SMD multiaxial spine malformation is feasible. Posterior column resection with segmental pedicle screw fixation and complementary fusion provides obvious curative effects for adult patients with neurologic complications.