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Johari AN, Nemade A, Dhawale A, Wadia F, Shah M. Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population. INTERNATIONAL ORTHOPAEDICS 2024; 48:1589-1598. [PMID: 38581468 DOI: 10.1007/s00264-024-06156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. METHODS Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. RESULTS A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was seven years (range 0.8 to 19 years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. CONCLUSION This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.
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Affiliation(s)
| | - Amit Nemade
- Department of Orthopedics, N K P Salve Institute of Medical Sciences & Research Centre, Nagpur, India
| | - Arjun Dhawale
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital and B.J. Wadia Hospital for Children, Mumbai, India.
| | - Farokh Wadia
- Southampton Children's Hospital, Southampton, UK
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Rajkumar S, Iyer RR, Stone L, Kelly MP, Plonsker J, Brandel M, Gonda DD, Mazur MD, Ikeda DS, Lucas DJ, Choi PM, Ravindra VM. Frequency and predictors of complication clustering within 30 days of spinal fusion surgery: a study of children with neuromuscular scoliosis. Spine Deform 2024; 12:727-738. [PMID: 38334901 PMCID: PMC11068681 DOI: 10.1007/s43390-023-00813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/23/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE There is limited information on the clustering or co-occurrence of complications after spinal fusion surgery for neuromuscular disease in children. We aimed to identify the frequency and predictive factors of co-occurring perioperative complications in these children. METHODS In this retrospective database cohort study, we identified children (ages 10-18 years) with neuromuscular scoliosis who underwent elective spinal fusion in 2012-2020 from the National Surgical Quality Improvement Program-Pediatric database. The rates of co-occurring complications within 30 days were calculated, and associated factors were identified by logistic regression analysis. Correlation between a number of complications and outcomes was assessed. RESULTS Approximately 11% (709/6677 children with neuromuscular scoliosis undergoing spinal fusion had co-occurring complications: 7% experienced two complications and 4% experienced ≥ 3. The most common complication was bleeding/transfusion (80%), which most frequently co-occurred with pneumonia (24%) and reintubation (18%). Surgical time ≥ 400 min (odds ratio (OR) 1.49 [95% confidence interval (CI) 1.25-1.75]), fusion ≥ 13 levels (1.42 [1.13-1.79]), and pelvic fixation (OR 1.21 [1.01, 1.44]) were identified as procedural factors that independently predicted concurrent complications. Clinical risk factors for co-occurring complications included an American Society of Anesthesiologist physical status classification ≥ 3 (1.73 [1.27-2.37]), structural pulmonary/airway abnormalities (1.24 [1.01-1.52]), impaired cognitive status (1.80 [1.41-2.30]), seizure disorder (1.36 [1.12-1.67]), hematologic disorder (1.40 [1.03-1.91], preoperative nutritional support (1.34 [1.08-1.72]), and congenital malformations (1.20 [1.01-1.44]). Preoperative tracheostomy was protective against concurrent complications (0.62 [0.43-0.89]). Significant correlations were found between number of complications and length of stay, non-home discharge, readmissions, and death. CONCLUSION Longer surgical time (≥ 400 min), fusion ≥ 13 levels and pelvic fixation are surgical risk factors independently associated with co-occurring complications, which were associated with poorer patient outcomes. Recognizing identified nonmodifiable risk factors might also be important for preoperative planning and risk stratification of children with neuromuscular scoliosis requiring spinal fusion. LEVEL OF EVIDENCE Level IV evidence.
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Affiliation(s)
- Sujay Rajkumar
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Rajiv R Iyer
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA
- Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Lauren Stone
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Michael P Kelly
- Department of Orthopedics, Rady Children's Hospital and University of California-San Diego Medical Center, San Diego, CA, USA
| | - Jillian Plonsker
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Michael Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - David D Gonda
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Pamela M Choi
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA.
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA.
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Ueda H, Iimura T, Inami S, Moridaira H, Yazawa T, Seo Y, Taneichi H. Histology and chronological magnetic resonance images of congenital spinal deformity: An experimental study in mice model. BMC Musculoskelet Disord 2024; 25:334. [PMID: 38671403 PMCID: PMC11046745 DOI: 10.1186/s12891-024-07460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The natural history of the congenital spinal deformity and its clinical magnitude vary widely in human species. However, we previously reported that the spinal deformities of congenital scoliosis mice did not progress throughout our observational period according to soft X-ray and MRI data. In this study, congenital vertebral and intervertebral malformations in mice were assessed via magnetic resonance (MR) and histological images. METHODS Congenital spinal anomalies were chronologically assessed via soft X-ray and 7 T MR imaging. MR images were compared to the histological images to validate the findings around the malformations. RESULTS Soft X-ray images showed the gross alignment of the spine and the contour of the malformed vertebrae, with the growth plate and cortical bone visible as higher density lines, but could not be used to distinguish the existence of intervertebral structures. In contrast, MR images could be used to distinguish each structure, including the cortical bone, growth plate, cartilaginous end plate, and nucleus pulposus, by combining the signal changes on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). The intervertebral structure adjacent to the malformed vertebrae also exhibited various abnormalities, such as growth plate and cartilaginous end plate irregularities, nucleus pulposus defects, and bone marrow formation. In the chronological observation, the thickness and shape of the malformed structures on T1WI did not change. CONCLUSIONS Spinal malformations in mice were chronologically observed via 7 T MRI and histology. MR images could be used to distinguish the histological structures of normal and malformed mouse spines. Malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. This study suggested the importance of MRI and histological examinations of human congenital scoliosis patients with patterns other than nonsegmenting patterns, which may be used to predict the prognosis of patients with spinal deformities associated with malformed vertebrae.
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Affiliation(s)
- Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan.
| | - Takuya Iimura
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Takuya Yazawa
- Department of Pathology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Yoshiteru Seo
- Department of Homeostatic Regulation, National Institute for Physiological Sciences, 38, Nishigonaka, Myodaiji, Okazaki, Aichi, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
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Bothara SS, Parihar P. A Case of Type 2 Diastematomyelia With Spina Bifida in a Pediatric Female Patient. Cureus 2024; 16:e55197. [PMID: 38558588 PMCID: PMC10981513 DOI: 10.7759/cureus.55197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
This case report presents the clinical and radiological findings of a seven-year-old female with type 2 diastematomyelia and spina bifida, emphasizing the complexity of congenital spinal anomalies in pediatric patients. The patient presented with a two-month history of lower back pain, prompting diagnostic investigations. Radiographic examination revealed spina bifida at the L3-L5 levels, subsequently confirmed by magnetic resonance imaging (MRI), which disclosed bifid spinous processes, an absent posterior arch, and a split spinal cord terminating at the L3-L4 disc levels. The Vancouver classification system facilitated a standardized characterization of congenital spinal anomalies. The multidisciplinary approach involving orthopedic and neurosurgical specialists led to a conclusive diagnosis of type 2 diastematomyelia with simple spinal dysraphism. Surgical intervention, encompassing laminectomy and correction of the split spinal cord, was successfully performed, resulting in the stabilization of the patient. This case underscores the importance of early diagnosis, advanced imaging modalities, and collaborative management in addressing rare congenital spinal anomalies. The discussion delves into the clinical implications, diagnostic challenges, and the pivotal role of surgical intervention. Insights from this case contribute to the existing literature, guiding healthcare professionals in understanding and managing similar cases with potential implications for future research and treatment strategies.
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Affiliation(s)
- Shivani S Bothara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Frasuńska J, Pollak A, Turczyn P, Kutkowska-Kaźmierczak A, Pepłowski J, Płoski R, Tarnacka B. A Study of Polish Family with Scoliosis and Limb Contractures Expands the MYH3 Disease Spectrum. Genes (Basel) 2024; 15:125. [PMID: 38275606 PMCID: PMC10815230 DOI: 10.3390/genes15010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
A disease associated with malfunction of the MYH3 gene is characterised by scoliosis, contractures of the V fingers, knees and elbows, dysplasia of the calf muscles, foot deformity and limb length asymmetry. The aim of this study was to identify the cause of musculoskeletal deformities in a three-generation Polish family by exome sequencing. The segregation of the newly described c.866A>C variant of the MYH3 gene in the family indicates an autosomal dominant model of inheritance. The detected MYH3 variant segregates the disease within the family. The presented results expand the MYH3 disease spectrum and emphasize the clinical diagnostic challenge in syndromes harbouring congenital spine defects and joint contractures.
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Affiliation(s)
- Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.F.); (B.T.)
| | - Agnieszka Pollak
- Department of Medical Genetics, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Paweł Turczyn
- Clinic of Early Arthritis, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | | | - Jakub Pepłowski
- The Rare Diseases Laboratory, Laboratory of Genetics, University Center for Laboratory Medicine, University Clinical Centre of the Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.F.); (B.T.)
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Wang S, Zhao Y, Du Y, Zhang J, Yu B. The incidence and interrelationship of hemivertebra and concomitant cardiac abnormalities in congenital scoliosis. BMC Musculoskelet Disord 2023; 24:621. [PMID: 37525123 PMCID: PMC10391902 DOI: 10.1186/s12891-023-06727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Congenital scoliosis(CS) is associated with multiple organs defect, and cardiac abnormalities have been reported commonly associated with CS. Hemivertebra is caused by the failure of vertebral formation, which is a major constitute of CS. Till now, few studies focus on the incidence and interrelationship of hemivertebra and concomitant cardiac abnormalities in congenital scoliosis. We aimed to analyze the cardiac defect in CS patients with or without hemivertebra, and further explore the incidence of cardiac defect between different types of hemivertebra. METHODS The ultrasonic cardiography (UCG) results of surgically treated congenital scoliosis (CS) patients between 2015 and 2018 were retrospectively analyzed. Patients were divided into hemivertebra group and non-hemivertebra group according to preoperative CT. Patients with hemivertebra was further divided into sub-group by single/multiple or fully/partially/mixed segmented hemivertebra. Demographic information, radiographic data and cardiac abnormalities were statistically compared between groups. RESULTS A total of 329 patients were analyzed, including 216 patients with hemivertebra and 113 patients without hemivertebra. UCG results were abnormal in 89 cases (27.1%), including 41 males(12.5%) and 48 females(14.6%). Hemivertebra group had comparable incidence of cardiac abnormalities with non-hemivertebra group (p = 0.517). No significant difference in the incidence of UCG abnormalities between single and multiple hemivertebra group (P = 0.246). Binary logistic regression analysis showed that female sex with multiple hemivertebra was a risk factor for abnormal UCG (P = 0.009, OR = 3.449). Cardiac abnormalities was comparable among fully, partially and mixed segmented hemivertebra group(P = 0.264). In abnormal UCG, 33 patients with hemivertebra had non-valvular abnormalities, and 48.5% (16/33) were septal defects. 28 patients had valvular abnormalities, most of them were mitral valve abnormalities, especially mitral valve redundancy, prolapse and insufficiency(82.1%, 23/28). No significant difference between the incidence of non-valvular and valvular abnormalities in patients with hemivertebra (P = 0.581). CONCLUSIONS The incidence of abnormal UCG results was approximately 28.2% in CS patients with hemivertebra. Female patients with multiple hemivertebra had a higher risk of UCG abnormalities. Mitral valve abnormalities were the most common abnormality of UCG found in CS patients with hemivertebra. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, P. R. China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, P. R. China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, P. R. China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, P. R. China
| | - Bin Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, P. R. China.
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Gao G, Tao B, Chen Y, Yang J, Sun M, Wang H, Hao F, Liu S, Wang M, Shang A. Fetal magnetic resonance imaging in the diagnosis of spinal cord neural tube defects: A prospective study. Front Neurol 2022; 13:944666. [PMID: 36003299 PMCID: PMC9393549 DOI: 10.3389/fneur.2022.944666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to evaluate the value of fetal magnetic resonance imaging (MRI) in the prenatal diagnosis of spinal neural tube defects. Methods From August 2018 to January 2021, 56 fetuses with suspected spinal cord neural tube defects were treated by prenatal ultrasound in the Neurosurgery Department of the First Medical Center of the People's Liberation Army General Hospital. Fetal MRI was performed within 72 h after ultrasound diagnosis. Forty singleton fetuses were selected. Magnetic resonance examination was performed within 1 month after birth, and the diagnostic coincidence rates of prenatal ultrasound and fetal magnetic resonance examination in the prenatal diagnosis of spinal cord neural tube defects were compared and analyzed using postnatal magnetic resonance examination as the standard. Results The coincidence rates of prenatal ultrasound and fetal MRI for the prenatal diagnosis of spina bifida were 71.4% (20/28) and 39.2% (11/28), respectively, and the difference was statistically significant. The coincidence rates of prenatal ultrasound and fetal MRI in the diagnosis of intraspinal lipoma were 52.6% (10/19) and 73.7% (14/19), respectively, and the difference was statistically significant. Conclusion Fetal MRI has an advantage over prenatal ultrasound in detecting intraspinal lipoma. Prenatal ultrasound has an advantage over fetal MRI in detecting spina bifida.
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Affiliation(s)
- Gan Gao
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Benzhang Tao
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
- Tianjin Medical University, Tianjin, China
| | - Yanyan Chen
- Department of Anesthesiology, The 960th Hospital of the Chinese People's Liberation Army (PLA), Taian, China
| | - Jiaqi Yang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Mengchun Sun
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Hui Wang
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Fangbin Hao
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Simeng Liu
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Minjie Wang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
| | - Aijia Shang
- Department of Neurosurgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Chinese People's Liberation Army (PLA) Medical School, Beijing, China
- *Correspondence: Aijia Shang
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Heiskanen S, Syvänen J, Helenius I, Kemppainen T, Löyttyniemi E, Gissler M, Raitio A. Increasing Prevalence and High Risk of Associated Anomalies in Congenital Vertebral Defects: A Population-based Study. J Pediatr Orthop 2022; 42:e538-e543. [PMID: 35297389 PMCID: PMC9005087 DOI: 10.1097/bpo.0000000000002124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Congenital vertebral anomalies are a heterogeneous group of diagnoses, and studies on their epidemiology are sparse. Our aim was to investigate the national prevalence and mortality of these anomalies, and to identify associated anomalies. METHODS We conducted a population-based nationwide register study and identified all cases with congenital vertebral anomalies in the Finnish Register of Congenital Malformations from 1997 to 2016 including live births, stillbirths, and elective terminations of pregnancy because of major fetal anomalies. Cases were categorized based on the recorded diagnoses, associated major anomalies were analyzed, and prevalence and infant mortality were calculated. RESULTS We identified 255 cases of congenital vertebral anomalies. Of these, 92 (36%) were diagnosed with formation defects, 18 (7.1%) with segmentation defects, and 145 (57%) had mixed vertebral anomalies. Live birth prevalence was 1.89 per 10,000, and total prevalence was 2.20/10,000, with a significantly increasing trend over time (P<0.001). Overall infant mortality was 8.2% (18/219); 3.5% (3/86) in patients with formation defects, 5.6% (1/18) in segmentation defects, and 12.2% (14/115) in mixed vertebral anomalies (P=0.06). Co-occurring anomalies and syndromes were associated with increased mortality, P=0.006. Majority of the cases (82%) were associated with other major anomalies affecting most often the heart, limbs, and digestive system. CONCLUSIONS In conclusion, the prevalence of congenital vertebral anomalies is increasing significantly in Finnish registers. Detailed and systematic examination is warranted in this patient population to identify underlying comorbidities as the majority of cases are associated with congenital major anomalies. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital
| | - Teemu Kemppainen
- Biostatistics, University of Turku and Turku University Hospital, Turku
| | | | - Mika Gissler
- Department of Information Services, Finnish Institute of Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Academic Primary Health Care Centre, Karolinska Institute, Stockholm, Sweden
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Birth defect co-occurrence patterns in the Texas Birth Defects Registry. Pediatr Res 2022; 91:1278-1285. [PMID: 34193968 PMCID: PMC8716666 DOI: 10.1038/s41390-021-01629-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The population-level landscape of co-occurring birth defects among infants without a syndromic diagnosis is not well understood. METHODS We analyzed data from 40,771 infants with two or more major birth defects in the Texas Birth Defects Registry (TBDR; 1999-2014). We calculated adjusted observed-to-expected (O/E) ratios for all two, three, four, and five-way combinations of 138 major defects. RESULTS Among 530 patterns with the highest adjusted O/E ratios (top 5% of 10,595 patterns), 66% included only defects co-occurring within one organ system and 28% were suggestive of known patterns (e.g., midline developmental defects). Of the remaining patterns, the combination of defects with the highest O/E ratio (193.8) encompassed the diaphragm, spine, spleen, and heart defects. Fourteen patterns involved heart and spine defects with or without rib defects. Ten additional patterns primarily involved two hallmark components of VACTERL association (specifically, vertebral defects, anal atresia, cardiac defects, renal, or limb defects, but not tracheoesophageal fistula). CONCLUSIONS Our analyses provide a description of the birth defect co-occurrence patterns in a multi-ethnic, population-based sample, and revealed several patterns of interest. This work complements prior work that has suggested etiologic connections between select defects (e.g., diaphragmatic hernia and heart and spleen anomalies; heart and spine defects). IMPACT In this large-scale, population-based study of birth defect co-occurrence patterns, we found several birth defect combinations of potential interest that warrant further investigation: congenital diaphragmatic hernia, heart, spine, and spleen defects and scimitar syndrome with vertebral defects. The majority of patterns of co-occurring defects observed more frequently than expected involved multiple defects within the same system and combinations suggestive of known associations. Nearly all of the top patterns (beyond the same system and those suggestive of known associations) involved organ systems that are components of the VACTERL association, with heart, spine, and rib defect patterns being the most common.
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Guzek RH, Murphy R, Hardesty CK, Emans JB, Garg S, Smith JT, Roye BD, Glotzbecker MP, Sturm PF, Snyder BD, Poon SC, Poe-Kochert C, Anari JB. Mortality in Early-Onset Scoliosis During the Growth-friendly Surgery Era. J Pediatr Orthop 2022; 42:131-137. [PMID: 35138296 DOI: 10.1097/bpo.0000000000001983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Early-onset scoliosis (EOS) is a spinal deformity that occurs in patients 9 years of age or younger. Severe deformity may result in thoracic insufficiency, respiratory failure, and premature death. The purpose of this study is to describe the modern-day natural history of mortality in patients with EOS. METHODS The multicenter Pediatric Spine Study Group database was queried for all patients with EOS who are deceased, without exclusion. Demographics, underlying diagnoses, EOS etiology, operative and nonoperative treatments or observation, complications, and date of death were retrieved. Descriptive statistics and survival analysis with Kaplan-Meier curves were performed. RESULTS There were 130/8009 patients identified as deceased for a registry mortality rate of 16 per 1000 patients. The mean age at death was 10.6 years (range: 1.0 to 30.2 y) and the most common EOS etiology was neuromuscular (73/130, 56.2%; P<0.001). Deceased patients were more likely be treated operatively than nonoperatively or observed (P<0.001). The mean age of death for patients treated operatively (12.3 y) was older than those treated nonoperatively (7.0 y) or observed (6.3 y) (P<0.001) despite a larger deformity and similar index visit body mass index and ventilation requirements. Kaplan-Meier analysis confirmed an increased survival time in patients with a history of any spine operation compared with patients without a history of spine operation (P<0.0001). Operatively treated patients experienced a median of 3.0 complications from diagnosis to death. Overall, cardiopulmonary related complications were the most common (129/271, 47.6%; P<0.001), followed by implant-related (57/271, 21.0%) and wound-related (26/271, 9.6%). The primary cause of death was identified for 78/130 (60.0%) patients, of which 57/78 (73.1%) were cardiopulmonary related. CONCLUSIONS This study represents the largest collection of EOS mortality to date, providing surgeons with a modern-day examination of the effects of surgical intervention to better council patients and families. Both fatal and nonfatal complications in children with EOS are most likely to involve the cardiopulmonary system. LEVEL OF EVIDENCE Level IV-therapeutic.
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Affiliation(s)
- Ryan H Guzek
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert Murphy
- Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | - Peter F Sturm
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH
| | | | | | | | - Jason B Anari
- Children's Hospital of Philadelphia, Philadelphia, PA
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11
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Hu Z, Xu Y, Li J, Zhu Z, Qiu Y, Liu Z. Bioinformatics Analysis and Experimental Verification Identify Downregulation of COL27A1 in Poor Segmental Congenital Scoliosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2616827. [PMID: 35186112 PMCID: PMC8849967 DOI: 10.1155/2022/2616827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Congenital scoliosis (CS) represents the congenital defect disease, and poor segmental congenital scoliosis (PSCS) represents one of its types. Delayed intervention can result in disability and paralysis. In this study, we would identify the core biomarkers for PSCS progression through bioinformatics analysis combined with experimental verification. METHODS This work obtained the GSE11854 expression dataset associated with somite formation in the GEO database, which covers data of 13 samples. Thereafter, we utilized the edgeR of the R package to obtain DEGs in this dataset. Then, GO annotation, KEGG analyses, and DO annotation of DEGs were performed by "clusterProfiler" of the R package. This study performed LASSO regression for screening the optimal predicting factors for somite formation. Through RNA sequencing based on peripheral blood samples from healthy donors and PSCS cases, we obtained the RNA expression patterns and screen out DEGs using the R package DESeq2. The present work analyzed COL27A1 expression in PSCS patients by the RT-PCR assay. RESULTS A total of 443 genes from the GSE11854 dataset were identified as DEGs, which were involved in BP associated with DNA replication, CC associated with chromosomal region, and MF associated with ATPase activity. These DEGs were primarily enriched in the TGF-β signaling pathway and spinal deformity. Further, LASSO regression suggested that 9 DEGs acted as the signature markers for somite formation. We discovered altogether 162 DEGs in PSCS patients, which were involved in BP associated with cardiac myofibril assembly and MF associated with structural constituent of muscle. However, these 162 DEGs were not significantly correlated with any pathways. Finally, COL27A1 was identified as the only intersected gene between the best predictors for somite formation and PSCS-related DEGs, which was significantly downregulated in PSCS patients. CONCLUSION This work sheds novel lights on DEGs related to the PSCS pathogenic mechanism, and COL27A1 is the possible therapeutic target for PSCS. Findings in this work may contribute to developing therapeutic strategies for PSCS.
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Affiliation(s)
- Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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12
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Yin X, Zhao X, Lu L, Zhang L, Xing Q, Yuan R, Niu Z, Zhang L. Fetal magnetic resonance imaging of lumbar spine development in vivo: a retrospective study. Childs Nerv Syst 2022; 38:2113-2118. [PMID: 35972535 PMCID: PMC9617832 DOI: 10.1007/s00381-022-05645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study is to describe MR imaging appearances of the fetal lumbar spine in vivo at different gestational ages (GAs). METHODS This retrospective study was approved by the Third Affiliated Hospital of Zhengzhou University. We collected MR images and clinical data of 93 fetuses in our hospital. All the MR images were obtained by 3-T MR. All had the mid-sagittal plane of steady state free precession sequence (Trufi) of the lumbar spine, which could show the lumbar vertebra and conus medullaris (CM). Regression analysis was made between GA and heights of lumbar vertebral body ossification center (LVBOC), lengths of LVBOC, and heights of intervertebral gap (IVG). RESULTS There were good linear correlations between the heights of LVBOC and GA (P < 0.001), lengths of LVBOC and GA (P < 0.001), and heights of IVG and GA (P < 0.001). CONCLUSION We showed the different development of each LVBOC and IVG which caused the difference of the shape of LVBOC and IVG.
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Affiliation(s)
- Xing Yin
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xin Zhao
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liying Zhang
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- grid.412719.8Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Yuan
- grid.412719.8Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhijun Niu
- grid.412719.8Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Zhang
- grid.412719.8Department of Laboratory Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Nabizadeh N, Dimar JR. Congenital spine deformities: timing of insult during development of the spine in utero. Spine Deform 2022; 10:31-44. [PMID: 34370207 DOI: 10.1007/s43390-021-00395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/28/2021] [Indexed: 12/24/2022]
Abstract
The development of the spine and spinal cord occurs at the earliest weeks of gestation. Their development not only affects each other but also are most likely associated with anomalies in other systems. It is essential to recognize the stages of spine development to understand the cause of congenital spinal deformities and their influences on the postnatal growing spine. A vast majority of congenital spinal problems are not evident clinically. For instance, the presence of neural axis abnormalities, such as spinal dysraphism or syringomyelia, may be so subtle that patients never seek medical care. Certain vertebral formation disorders such as hemivertebrae may remain asymptomatic throughout life if they are balanced while those with congenital bars may develop severe deformity. Major defects in the spine are often associated with abnormalities of the other organs such as cardiovascular and genital urinary system that warrants close attention by multidisciplinary specialists. A thorough understanding of the basics of embryology, which serves as a window into the development of the spine, is necessary to enable the practitioner to appreciate why, when, and where the numerous spine deformities develop in utero. Besides, certain developmental defects manifest in adulthood including spondylolysis, degenerative disc disease, congenital spinal stenosis, and even tumors like cordoma. Thus, understanding embryology can assist to establish the proper diagnosis and ensure optimal treatment.
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Affiliation(s)
- Naveed Nabizadeh
- Norton Leatherman Spine Center, University of Louisville, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA.
| | - John R Dimar
- Norton Leatherman Spine Center, University of Louisville, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA
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14
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[Surgical strategies in the treatment of neuromuscular scoliosis]. DER ORTHOPADE 2021; 50:633-637. [PMID: 34228160 DOI: 10.1007/s00132-021-04128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
As part of the underlying condition, neuromuscular scoliosis occurs in early childhood. Compared to idiopathic scoliosis, neuromuscular scoliosis shows a more rapid progress of deformity, which continues even after the end of growth. This progress and the associated complications can only be prevented by surgical treatment. Depending on the patient's age and the extent of the deformity, different strategies have been established: in early childhood, so-called "growing implants" are used, while between the ages of 10 to 12, definitive treatment by reposition and fusion of the deformity is the treatment of choice. In this review, we present different surgical strategies as well as indications for surgery and discuss challenges in the treatment of these complex deformities.
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15
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Kwon JW, Chae HW, Lee HS, Kim S, Sung S, Lee SB, Moon SH, Lee HM, Lee BH. Incidence rate of congenital scoliosis estimated from a nationwide health insurance database. Sci Rep 2021; 11:5507. [PMID: 33750891 PMCID: PMC7943574 DOI: 10.1038/s41598-021-85088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the epidemiology of congenital scoliosis (CS) and treatment trends. An age-matched, nationwide, population-based study was conducted using the National Health Insurance and Health Insurance Review and Assessment databases from 2010 to 2015. Data regarding the diagnosis and treatment of scoliosis were extracted using International Classifications of Diseases, 10th revision codes. The age-matched normal population was determined from the Korean Statistical Information Service database. We analyzed the incidence rate of CS according to age and sex, as well as the proportion of surgically treated patients. A total of 1664 patients (aged 0-19 years) were diagnosed with CS. The overall average incidence rate of CS over the 5-year period was 3.08 per 100,000 persons, with the highest and second highest rates at 0 years and 12-16 years of age, respectively. The incidence rate stratified by age ranged from 1.5 to 20.1 per 100,000 persons among the age-matched normal population, with peaks at 0 years of age and the second growth spurt in adolescence (12-16 years for males; 10-14 years for females). Anterior surgery was rarely performed; posterior surgery was performed in 92 patients (5.5% of all patients), with the highest prevalence (56.5%) in patients diagnosed at 10-14 years of age. The overall average incidence rate of CS over a 5-year period was 3.08 per 100,000 persons. Only 5.5% of patients underwent surgery within 5 years after the initial diagnosis.
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Affiliation(s)
- Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Department of Orthopedic Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sinae Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sahyun Sung
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soo Bin Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.,Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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16
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Wang F, Wang X, Medina O, Yong M, Lin G, Sun X, Zhang Z, Tang K, Lou Y. Prevalence of congenital scoliosis in infants based on chest-abdomen X-ray films detected in the emergency department. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1848-1857. [PMID: 33646418 DOI: 10.1007/s00586-021-06779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the prevalence of congenital scoliosis (CS) in infants based on chest-abdomen radiographs. METHODS A retrospective review was conducted on infants in the emergency department (ED) of a tertiary children's hospital between February 2008 and September 2019. Patients who had undergone chest-abdomen X-rays were included. All films from the enrolled patients were screened for CS. Their demographic characteristics, type, and location of the vertebral and rib anomalies, and concomitant defects of other systems were analyzed. RESULTS In total, 50,426 infants were enrolled; 89 (1.8‰) were diagnosed with CS, including 56 males and 33 females. There was no gender difference in CS prevalence. The visiting age of the CS patients (70 ± 98days) was significantly younger than that of the non-CS group (P < 0.05), with CS patients mainly visiting for digestive (53.9%) and respiratory symptoms (41.6%). Sixty-eight (76.4%) CS patients had main thoracic (T6-T11) vertebral malformations. Rib anomalies were documented in 27 (30.3%) patients, of which 14 had complex rib anomalies. Forty (44.9%) patients had concomitant defects of other organs, of which eight patients had two systemic abnormalities mixed. The most common extraspinal defects were imperforate anus (21, 23.6%) and congenital cardiac defects (17, 19.1%). CONCLUSION The prevalence of CS in infants based on chest-abdomen X-rays in the ED was 1.8‰. Both the vertebral and rib anomalies mainly affected the main thoracic region. The spine deformities in infants with concomitant defects of other organs could be identified earlier because of early-onset symptoms, which also bring out a selection bias in our analysis.
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Affiliation(s)
- Fei Wang
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xin Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Omar Medina
- Department of Orthopaedic Surgery, Habor-UCLA Medical Center, Los Angeles, United States
| | - Ming Yong
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Gang Lin
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Xiangshui Sun
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhiqun Zhang
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Kai Tang
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yue Lou
- Department of Orthopedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
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17
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Trapp B, de Andrade Lourenção Freddi T, de Oliveira Morais Hans M, Fonseca Teixeira Lemos Calixto I, Fujino E, Alves Rojas LC, Burlin S, Cerqueira Costa DM, Carrete Junior H, Abdala N, Tobaru Tibana LA, Takehara ET, Dalul Gomez G. A Practical Approach to Diagnosis of Spinal Dysraphism. Radiographics 2021; 41:559-575. [PMID: 33449837 DOI: 10.1148/rg.2021200103] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spinal dysraphisms (SDs) are congenital malformations of the spinal cord, determined by derangement in the complex cascade of embryologic events involved in spinal development. They represent a heterogeneous group ranging from mild clinical manifestations-going unnoticed or being discovered at clinical examination-to a causal factor of life quality impairment, especially when associated with musculoskeletal, gastrointestinal, genitourinary, or respiratory system malformations. Knowledge of the normal embryologic development of the spinal cord-which encompasses three main steps (gastrulation, primary neurulation, and secondary neurulation)-is crucial for understanding the pathogenesis, neuroradiologic scenarios, and clinical-radiologic classification of congenital malformations of the spinal cord. SDs can be divided with clinical examination or neuroradiologic study into two major groups: open SDs and closed SDs. Congenital malformations of the spinal cord include a wide range of abnormalities that vary considerably in imaging and clinical characteristics and complexity and therefore may represent a diagnostic challenge, even for the experienced radiologist. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Bárbara Trapp
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Tomás de Andrade Lourenção Freddi
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Monique de Oliveira Morais Hans
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Isadora Fonseca Teixeira Lemos Calixto
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Emi Fujino
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Laila Cristina Alves Rojas
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Stênio Burlin
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Danilo Manuel Cerqueira Costa
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Henrique Carrete Junior
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Nitamar Abdala
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Luís Antônio Tobaru Tibana
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Eduardo Takashi Takehara
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Gustavo Dalul Gomez
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
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Wang L, Zhao H, Zhu W, Yan P, Teng YD. A Combinatorial Approach with Cerebellar Tonsil Suspension to Treating Symptomatic Chiari Malformation Type I in Adults: A Retrospective Study. World Neurosurg 2020; 143:e19-e35. [DOI: 10.1016/j.wneu.2020.02.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
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Answer to the letter to the editor of V. Kumar et al. concerning "influence of body position and axial load on spinal stiffness in healthy young adults" by Häusler M, et al. (Eur Spine J; [2020]: DOI:10.1007/S00586-019-06254-0). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1778-1779. [PMID: 32361844 DOI: 10.1007/s00586-020-06438-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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K. S S, Naduvanahalli Vivekanandaswamy A, Shetty AP, Kanna RM, Rajasekaran S. Progressive hemiparesis due to spino-laminar anomaly of the axis-a case report and literature review. Spinal Cord Ser Cases 2019; 5:69. [PMID: 31632727 PMCID: PMC6786353 DOI: 10.1038/s41394-019-0214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Some of the most common developmental malformations of the axis include anomalies of the odontoid, for example, hypoplasia or aplasia. Isolated anomalies of the posterior arch of the axis rarely occur. This study reports a unique case of congenital anomaly of the neural arch of the axis vertebra, which manifested clinically as progressive hemiparesis. Case presentation A 33-year-old man presented with progressive weakness of the right upper and lower limbs that had lasted 18 months. The patient reported loss of right-hand dexterity in the 6 months period before he consulted us. Plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) revealed C5-C6 block vertebra, primary canal stenosis and spino-laminar anomaly of the axis, along with invagination of the lamina into the canal causing severe cord compression. Discussion The anomalous posterior element of the axis was excised, and the cord was decompressed. The presence of congenital stenosis and block vertebrae at the C5-C6 level necessitated decompression and instrumentation between C2-C6. Simultaneous occurrence of a posterior arch anomaly, primary canal stenosis, and block vertebra has not been previously described. A cervical spine anomaly presenting as hemiparesis is uncommon in clinical practice. Information enabling clinicians to identify causative anomaly and determine the appropriate surgical intervention is useful, and can facilitate a good clinical outcome.
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Affiliation(s)
- Srivijayanand K. S
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
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Excision and short segment fusion of a double ipsilateral lumbar hemivertebrae associated with a diastematomyelia and fixed pelvic obliquity. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:160-164. [PMID: 30718132 PMCID: PMC6506818 DOI: 10.1016/j.aott.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 01/05/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
We report the surgical treatment course of a 4-year-old girl with congenital scoliosis, diastematomyelia and double adjacent hemivertebrae. She had a lumbar curve with an apparent pelvic obliquity. Simultaneous excision of double segmented sequential hemivertebra at the L3–L4 level and fusion with short-segment instrumentation was performed via a posterior approach. Intraoperative radiographs revealed satisfactory curve correction and 0° pelvic obliquity. Following the excision of double adjacent hemivertebrae, three adjacent nerve roots were placed in one intervertebral foramen bilaterally. Nevertheless, no neurological deficit was developed, and the patient was able to ambulate with a brace at day one. Pelvic balance and deformity correction were maintained with no implant failure at the fifth year follow-up. Excision of two ipsilateral adjacent hemivertebra and short-segment posterior fusion performed via posterior-only approach simultaneously is an effective, safe, and less invasive technique for the treatment of the described case.
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Pavone V, Testa G, Lucenti L, Falsaperla R, Sessa G. Transverse cervical megapophysis as an uncommon cause of torticollis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Chaturvedi A, Klionsky NB, Nadarajah U, Chaturvedi A, Meyers SP. Malformed vertebrae: a clinical and imaging review. Insights Imaging 2018; 9:343-355. [PMID: 29616497 PMCID: PMC5991006 DOI: 10.1007/s13244-018-0598-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 12/21/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
A variety of structural developmental anomalies affect the vertebral column. Malformed vertebrae can arise secondary to errors of vertebral formation, fusion and/or segmentation and developmental variation. Malformations can be simple with little or no clinical consequence, or complex with serious structural and neurologic implications. These anomalies can occasionally mimic acute trauma (bipartite atlas versus Jefferson fracture, butterfly vertebra versus burst fracture), or predispose the affected individual to myelopathy. Accurate imaging interpretation of vertebral malformations requires knowledge of ageappropriate normal, variant and abnormal vertebral morphology and the clinical implications of each entity. This knowledge will improve diagnostic confidence in acute situations and confounding clinical scenarios. This review article seeks to familiarize the reader with the embryology, normal and variant anatomy of the vertebral column and the imaging appearance and clinical impact of the spectrum of vertebral malformations arising as a consequence of disordered embryological development. Teaching points • Some vertebral malformations predispose the affected individual to trauma or myelopathy. • On imaging, malformed vertebrae can be indistinguishable from acute trauma. • Abnormalities in spinal cord development may be associated and must be searched for. • Accurate interpretation requires knowledge of normal, variant and abnormal vertebral morphology.
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Affiliation(s)
- Apeksha Chaturvedi
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Nina B Klionsky
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | | | - Abhishek Chaturvedi
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | - Steven P Meyers
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
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