Scoliosis correction in an adolescent with a rigid spine syndrome: case report

Staged Management of Cervicothoracic Lordosis and Scoliosis in an Emery-Dreifuss VI Muscular Dystrophy Patient: A Case Report

CASE

We report the case of an 18-year-old man with extreme cervicothoracic lordosis and a progressive scoliosis secondary to Emery-Dreifuss Type VI muscular dystrophy. In a staged fashion, the patient underwent posterior cervical muscle release, halo-gravity traction, and posterior instrumented spinal fusion from C3-L4 with multiple posterior column osteotomies. The patient was followed over 2 years postoperatively with restoration of normal spinal alignment in both the coronal and sagittal profiles.

CONCLUSION

This is the first reported case illustrating the gradual correction of severe lordoscoliosis in this patient population.

Cervical Hyperextension Treated by Posterior Spinal Correction and Fusion in A Patient with Ullrich Congenital Muscular Dystrophy: A Case Report

CASE

An 18-year-old man with Ullrich congenital muscular dystrophy (UCMD) noted difficulty of looking forward and discomfort swallowing and breathing because of his hyperextended neck. We treated his cervical deformity with posterior spinal correction and fusion alone. He underwent a tracheotomy because of lung function deterioration 2 years after cervical surgery. The tracheotomy was performed safely because the anterior cervical spine anatomy was normalized and soft tissues around trachea were preserved by the posterior cervical correction.

CONCLUSION

Cervical hyperextension can be a problem in patients with UCMD. Posterior spinal correction and fusion may be a preferable solution.

Cervical Hyperextension Deformity After Sagittal Balance Correction in Patient with Congenital Limb-Girdle Myopathy: Surgical Technique and Review of Literature

BACKGROUND

There is no gold standard surgical treatment for cervical hyperextension deformity, especially in case of muscular dystrophy. Special considerations and caution should be taken as they carry a high risk of early mortality and spinal cord injury. Only a few case reports are available in the literature.

CASE DESCRIPTION

We report a case of surgical correction of an iatrogenic cervical hyperextension deformity following sagittal balance correction in a patient with congenital limb-girdle myopathy. The patient was successfully treated by posterior cervical release and fusion after verification of the range of motion, reducibility of the deformity, and absence of any positional spinal cord compression with dynamic radiographic examination and preoperative magnetic resonance imaging in the desired postoperative position.

CONCLUSIONS

We suggest posterior cervical release and fusion in case of a radiologically and clinically reducible cervical hyperextension deformity under both motor and sensory spinal evoked potential monitoring. In cases of longstanding, rigid, nonreducible cervical hyperextension, laminectomy and concomitant duroplasty could be considered.

Spinal Deformity in Bethlem Myopathy

STUDY DESIGN

Retrospective review.

OBJECTIVES

To report the characteristics of spinal deformity in a series of 3 patients with Bethlem myopathy.

SUMMARY OF BACKGROUND DATA

Bethlem myopathy presents with mild muscular weakness and typically has a benign course. Severe scoliosis in patients affected with Bethlem myopathy has not been previously reported.

METHODS

Clinical records of 3 brothers with Bethlem myopathy were reviewed. Clinical and radiographic features of the spinal deformity are presented.

RESULTS

All 3 patients had progressive scoliosis with coronal and sagittal imbalance. At a minimum of 26 months of follow-up after posterior instrumented fusion, there were no complications and deformity correction was maintained. Posterior instrumentation and fusion did not negatively affect the pulmonary function in this group of patients with Bethlem myopathy.

CONCLUSIONS

Bethlem myopathy may present with severe scoliosis along with proximal muscle weakness. This condition should be included in the differential diagnosis of adolescent patients with progressive spinal deformity.

Selenoprotein N in skeletal muscle: from diseases to function

Selenoprotein N (SelN) deficiency causes several inherited neuromuscular disorders collectively termed SEPN1-related myopathies, characterized by early onset, generalized muscle atrophy, and muscle weakness affecting especially axial muscles and leading to spine rigidity, severe scoliosis, and respiratory insufficiency. SelN is ubiquitously expressed and is located in the membrane of the endoplasmic reticulum; however, its function remains elusive. The predominant expression of SelN in human fetal tissues and the embryonic muscle phenotype reported in mutant zebrafish suggest that it is involved in myogenesis. In mice, SelN is also mostly expressed during embryogenesis and especially in the myotome, but no defect was detected in muscle development and growth in the Sepn1 knock-out mouse model. By contrast, we recently demonstrated that SelN is essential for muscle regeneration and satellite cell maintenance in mice and humans, hence opening new avenues regarding the pathomechanism(s) leading to SEPN1-related myopathies. At the cellular level, recent data suggested that SelN participates in oxidative and calcium homeostasis, with a potential role in the regulation of the ryanodine receptor activity. Despite the recent and exciting progress regarding the physiological function(s) of SelN in muscle tissue, the pathogenesis leading to SEPN1-related myopathies remains largely unknown, with several unsolved questions, and no treatment available. In this review, we introduce SelN, its properties and expression pattern in zebrafish, mice, and humans, and we discuss its potential roles in muscle tissue and the ensuing clues for the development of therapeutic options.

Mortality and morbidity associated with correction of severe cervical hyperextension

STUDY DESIGN

Three case reports of patients with treatment of severe cervical hyperextension.

OBJECTIVE

Cervical hyperextension is a rare spine deformity that is associated with myopathies. Previous reports of surgical correction have reported no major operative complications. This report outlines our experience with 3 patients who experienced significant complications.

SUMMARY OF BACKGROUND DATA

The limited literature on the treatment of cervical hyperextension has good to excellent outcomes.

METHODS

Three case reports are presented.

RESULTS

Three cases with severe cervical hyperextension with intraoperative correction had associated morbidity and mortality. One case had a failed intubation requiring tracheotomy. This was followed by a successful posterior release with halo traction for 2 weeks and then an instrumented posterior cervical fusion. This patient died at home 2 weeks after surgery. The second and third cases had an intraoperative spinal cord injury during a posterior release for cervical hyperextension.

CONCLUSION

Patients with severe cervical hyperextension have high neurologic perioperative risk.

Examination of the newborn with congenital scoliosis: focus on the physical

Although scoliosis at birth is rare, conditions at birth and in the newborn period predispose newborns to the development of scoliosis in later life. Scoliosis is congenital when associated with abnormal vertebral segmentation regardless of the age of diagnosis. Other conditions may predispose neonates to vertebral damage or the development of sustained uneven forces on the developing spine. Although it is difficult to know which newborns will progress to developing scoliosis, it is important to be aware of risk factors to provide anticipatory education for parents and to arrange appropriate follow-up after discharge. This article reviews the embryology of vertebral formation and risk factors for the development of scoliosis. The discussion includes the incidence, risk factors, genetics, associated problems, physical examination, and nursing implications of the infant with congenital scoliosis.