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Imamura H, Hamano Y, Kamijo H, Ichikawa M, Kashima Y, Oba H. Successful recovery from cardiac arrest due to atlantoaxial subluxation in Down syndrome: a case report. Spinal Cord Ser Cases 2024; 10:37. [PMID: 38796439 PMCID: PMC11127916 DOI: 10.1038/s41394-024-00649-y] [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: 11/06/2023] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/28/2024] Open
Abstract
INTRODUCTION Down syndrome is the most common chromosomal abnormality associated with intellectual impairments. Unexpected deaths are common with this disease. There are certain difficulties in clarifying the cause of death because the manifestations may be quite diverse and involve many organ systems. Atlantoaxial subluxation is a dangerous complication of Down syndrome, as it may lead to cervical cord-medullary compression. CASE PRESENTATION Herein, we present a case of Down syndrome in a patient who completely recovered from cardiac arrest due to atlantoaxial subluxation. The neck was immobilized during post-cardiac arrest care, and the patient underwent surgery after 14 days. The patient could walk independently and was discharged 3 months later. At the last follow-up 5 years after surgery, the patient's general condition was good. DISCUSSION Physicians should be aware that atlantoaxial instability can cause cardiac arrest in patients with genetic syndromes.
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Affiliation(s)
- Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Yujiro Hamano
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Kamijo
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Michitaro Ichikawa
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuichiro Kashima
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroki Oba
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Amanullah AA, Oh T, Toll BJ, Patel A, Samdani AF, Pahys JM, Kim AJ, Vellanki A, Steindler J, Ishmael TG, Hwang SW. Risk Factors for Progression of Cervical Congenital Scoliosis and Associated Compensatory Curve Behavior. J Clin Med 2024; 13:3039. [PMID: 38892749 PMCID: PMC11172909 DOI: 10.3390/jcm13113039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study investigated risk factors for progression of deformity in pediatric congenital cervical scoliosis (CCS) and evaluated the correlation between congenital cervical curves and compensatory thoracic and lumbar curves. Methods: Medical records were retrospectively reviewed for 38 pediatric patients with CCS with a minimum 2-year follow-up. Curve progression was defined as >10° increase in cervical coronal curve angle between presentation and last follow-up. Results: A total of 38 patients (16 girls, 22 boys) with a mean age at presentation of 5.6 ± 4.1 years met the inclusion criteria. Sixteen patients (42%) had curve progression with a mean follow-up of 3.1 ± 3.0 years. At presentation, T1 slope was significantly larger among children with progressive deformities (p = 0.041). A total of 18 of the 38 patients with strictly cervical spine deformity were then selected for subanalysis to evaluate the progression of compensatory curves. Cervical major coronal curves were found to significantly correlate with lumbar major coronal curves (r = 0.409), C2 central sacral vertical line (CSVL) (r = 0.407), and C7-CSVL (r = 0.403) (p < 0.05). Thoracic major coronal curves did not significantly correlate with cervical major coronal curves (r = 0.218) (p > 0.05). Conclusion: In conclusion, 42% of osseous CCS curves progressed over time in the overall cohort, and high initial T1 slope was found to be most highly correlated with progression of cervical deformity. Cervical major coronal curves significantly correlated with lumbar curve magnitude but not with thoracic curve size in isolated CCS, possibly due to the increased flexibility of the lumbar spine which may allow greater compensatory balance and thus have a greater correlation with cervical curve magnitude and possibly progression.
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Affiliation(s)
- Amir A. Amanullah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA;
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Taemin Oh
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Brandon J. Toll
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Akul Patel
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Amer F. Samdani
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Joshua M. Pahys
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Andrew Jeongyoon Kim
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Aniketh Vellanki
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Jessica Steindler
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Terrence G. Ishmael
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
| | - Steven W. Hwang
- Shriners Children’s–Philadelphia, Philadelphia, PA 19140, USA; (T.O.); (A.F.S.); (J.M.P.); (A.J.K.); (A.V.); (J.S.); (T.G.I.)
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Tetreault TA, Andras LM, Tolo VT. Spinal Manifestations of Skeletal Dysplasia: A Practical Guide for Clinical Diagnosis. J Am Acad Orthop Surg 2024; 32:e425-e433. [PMID: 38470978 DOI: 10.5435/jaaos-d-23-00974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024] Open
Abstract
Skeletal dysplasias are a group of genetic conditions defined by atypical bone or cartilage growth and development. Skeletal abnormalities include short stature, limb deformity, joint contracture, and spinal deformity. Over 90% of disorders have a known genetic mutation that can definitively determine the diagnosis. As patients may present with a primary spinal concern, a careful clinical and radiographic evaluation can allow the physician to develop a working diagnosis to guide additional evaluation. Spinal manifestations include scoliosis and kyphoscoliosis, cervical instability, cervical kyphosis, thoracolumbar kyphosis, spinal stenosis, and atypical vertebral body morphology. An understanding of the affected conditions, prevalence, and natural history of these radiographic findings aids the orthopaedic surgeon in establishing a diagnosis and guides appropriate orthopaedic care.
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Affiliation(s)
- Tyler A Tetreault
- From the Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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Kumarasamy S, Sawarkar DP, Singh PK, Kumar R, Chandra PS, Kale SS. Cervical kyphosis correction in Marfan syndrome: our experience and literature review. Childs Nerv Syst 2024; 40:495-502. [PMID: 37391518 DOI: 10.1007/s00381-023-06046-4] [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: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Spinal deformities are common in Marfan syndrome (MFS). They usually involve the thoraco-lumbar spine but rarely involves the cervical spine. Kyphosis is the common spine deformity of the cervical spine and mandates surgical correction as they are at risk of neurological deterioration since they are refractory to conservative management. Few studies of surgical correction of spine deformity included cervical deformity. OBJECTIVES To analyze the challenges faced during surgery, clinical and radiological outcome, and complications following surgical correction for cervical kyphosis in Marfan syndrome. METHODS We identified that 5 patients with a diagnosis of MFS with cervical kyphosis who underwent fusion surgery between the years 2010 and 2022 were reviewed, retrospectively. We analyzed the demographic details, radiological parameters, operative variables (blood loss and nuances), perioperative complications, length of stay, clinical and radiological outcome, and complications following fusion surgery for cervical kyphosis in MFS. RESULTS The mean age of patients was 16.6 ± 4.72 years (range, 12-23 years). The average kyphotic vertebra involved is 3 ± 0.7 bodies (range 2-4) with 2 patients with thoracic deformity. All patients underwent surgical deformity correction. All patients improved clinically with Nurick grade (pre vs. post: 3.4 vs. 2.2) and mJOA (pre vs. post: 8.2 vs. 12.6). There was significant deformity correction from 37.48° to 9.1°. Mean blood loss encountered was 900 ± 173.2 ml. Perioperative complications: wound complication with CSF leak (1). Late complications: ventilator dependence (1) and junctional kyphosis (1). Mean length of hospital stay was 103 ± 178.9 days. All patients were doing symptomatically better after mean follow-up of 58 ± 28.32 months. One patient is bedridden and hospitalized. CONCLUSION Cervical kyphosis is a rare spine deformity in patients with MFS, and they usually present with neurological deterioration mandating surgical correction. Multidisciplinary approach (pediatrics, genetics and cardiology) is required for systematic evaluation of these patients. They should be evaluated with necessary imaging to rule out associated spinal deformity (atlanto-axial subluxation, scoliosis, and intraspinal pathology like ductal ectasia). Our results suggest better surgical outcome in terms of low operative complications with neurologic improvement in MFS patients. These patients require regular follow-up to identify late complications (instrument failure, non-union, and pseudarthrosis).
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Affiliation(s)
- Sivaraman Kumarasamy
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Dattaraj P Sawarkar
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Rajinder Kumar
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, 110029, India
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Menezes AH. Os odontoideum: database analysis of 260 patients regarding etiology, associated abnormalities, and literature review. Front Surg 2023; 10:1291056. [PMID: 38116481 PMCID: PMC10728483 DOI: 10.3389/fsurg.2023.1291056] [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: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Since the first description of os odontoideum in 1886, its origin has been debated. Numerous case series and reports show both a possible congenital origin and origin from the secondary to craniovertebral junction (CVJ) trauma. We conducted a detailed analysis of 260 surgically treated cases to document the initial symptoms, age groups, radiographic findings, and associated abnormalities, aiming to enhance the confirmation of the etiology. A literature search (1970-2022) was performed to correlate our findings. Methods and materials A total of 260 patients underwent surgical management of a referral database of 520 cases (1978-2022). All patients were examined by plain radiography and myelotomography as needed until 1984, and since then, CT and MRI have been employed. History of early childhood (aged below 6 years) CVJ trauma was investigated, including obtaining emergency department's initial radiographs from the referral and subsequent follow-up. Associated radiographic and systemic abnormalities were noted, and the atlas development was followed. Results The age of the patients ranged from 4 to 68 years, mostly between 10 and 20 years. There were 176 males and 86 females. Orthotopic os odontoideum was identified in 24 patients, and 236 patients had dystopic os odontoideum. Associated abnormalities were found in 94 of 260 patients, with 73 exhibiting syndromic abnormalities and 21 having Chiari I malformation. Two sets of twins had spondyloepiphyseal dysplasia. Of 260 patients, 156 experienced early childhood trauma /. Among these, 54 initially presented with normal radiographs but later demonstrated anterior atlas hypertrophy. In addition, a smaller posterior C1 arch was observed, leading to the development of os odontoideum. Two children had initial CVJ trauma as documented by MRI, with subsequent classical findings of os odontoideum and atlas changes. Syndromic patients had an earlier presentation. The literature reviewed confirms the multifactorial etiology. Conclusions The early presentation and associated abnormalities (such as Down syndrome, Klippel-Feil syndrome, Chiari I malformation, spondyloepiphyseal dysplasia, Morquio syndrome, and others) along with case reports documenting familial, hereditary, and twin presentations strongly support a congenital origin. Likewise, surgical complications are more prevalent in syndromic patients (40%) compared to 15% in other cases, as reported in the literature. The documentation of normal odontoid in early childhood trauma cases followed by the later development of os odontoideum provides evidence supporting trauma as an etiological factor. This process also involves vascular changes in both the atlas and the formation of os odontoideum. Associated abnormalities exhibit an earlier presentation and are only seen in cases with a non-traumatic origin.
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Affiliation(s)
- Arnold H. Menezes
- Neurosurgery & Pediatrics, University of Iowa Hospitals & Clinics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, United States
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Matabele MN, Kille TL, Gorelik M, Van Beek-King J, Legare JM, Stadler JA, Iskandar BJ, Wheeler BJ, Puricelli MD. Intraoperative neural monitoring during head and neck surgery in patients with concern for cervical spine instability. Int J Pediatr Otorhinolaryngol 2023; 175:111749. [PMID: 37839292 DOI: 10.1016/j.ijporl.2023.111749] [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: 07/01/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
Cervical and craniocervical instability are associated with catastrophic procedural outcomes. We discuss three individuals who required otolaryngologic surgical intervention: two with symptomatic spinal instability and one in whom spinal stability was unable to be assessed. Two cases were managed with procedural positioning precautions and evoked potential monitoring, and the other with procedural positioning precautions alone. Methods of monitoring and triggers for repositioning are discussed. This series is intended to discuss the approach and potential added value of evoked potential monitoring for risk mitigation in pediatric patients with concern for cervical spine instability.
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Affiliation(s)
- Maya N Matabele
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tony L Kille
- Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Gorelik
- Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Jessica Van Beek-King
- Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Janet M Legare
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - James A Stadler
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Bermans J Iskandar
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan J Wheeler
- Department of Neurology, University of Wisconsin Health, Madison, WI, USA
| | - Michael D Puricelli
- Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA.
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Goodwin AM, Hsu WK. Congenital Cervical Stenosis: a Review of the Current Literature. Curr Rev Musculoskelet Med 2023; 16:438-445. [PMID: 37452915 PMCID: PMC10427602 DOI: 10.1007/s12178-023-09857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Congenital cervical stenosis (CCS) is a phenomenon in which an individual has a narrow canal due to abnormal anatomy which can present with earlier degenerative symptoms due to a reduced sagittal diameter. The diagnosis of CCS is important to individual treatment and preventative measures. Often, athletes are warned against sport participation that may cause damage to the cervical spine. There may be a predisposition in certain populations, but lack of data limits conclusions. The current review investigates recent literature on the definition, pathoanatomy, clinical presentation, and management of CCS. It specifically interrogates potential populations predisposed to this condition. RECENT FINDINGS The current literature reveals a potential predisposition for CCS in the black population when compared to the white population; however, many studies do not report race when discussing CCS patients. The lack of data limits a consensus on specific populations with a congenitally narrow canal. CCS may be more prevalent in specific populations. With knowledge of populations more at risk for this condition, physicians and teams can be alert when evaluating players and young adults. Furthermore, this may provide insight into risk for symptoms with degenerative disease. These findings introduce an avenue for further research into CCS.
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Affiliation(s)
- Alyssa M Goodwin
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA.
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA.
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
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Siafaka A, Angelis S, Piagkou M, Apostolopoulos A, Troupis T, Filippou D. Larsen Syndrome and Associated Spinal Deformities. Cureus 2023; 15:e41655. [PMID: 37565102 PMCID: PMC10411917 DOI: 10.7759/cureus.41655] [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] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Larsen syndrome is a rare genetic disorder that affects the connective tissue within the body. The present narrative review aims to examine the genetic basis of Larsen syndrome, clarify its symptoms, and define all the existing therapeutic approaches. A comprehensive search was performed in the PubMed database. Inclusion criteria considered molecular and clinical studies, management and surgical treatment of related deformities, case reports of patients with the syndrome, reviews of the associated anomalies, articles whose full text is available in PubMed, and articles published in the English language. Larsen syndrome is caused by mutations in the FLNB gene, which encodes the cytoskeletal protein filamin B, crucial in the development of the skeleton. Symptoms include joint dislocations, characteristic facial features and anomalies of the spine. Larsen syndrome may be conservatively treated initially, although surgical intervention is usually required. Various surgical techniques, including posterior spinal fusion, anterior decompression, circumferential arthrodesis, and single-stage 360° fixation, have been proposed along with growth-sparing procedures. Preoperative and postoperative care and education ensure optimal results. Further research is needed to identify novel therapeutic modalities for this condition.
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Affiliation(s)
- Angeliki Siafaka
- Anatomy Department, National and Kapodistrian University of Athens, Athens, GRC
| | - Stavros Angelis
- Anatomy Department, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Piagkou
- Anatomy Department, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Theodore Troupis
- Anatomy Department, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Filippou
- Anatomy Department, National and Kapodistrian University of Athens, Athens, GRC
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Menger RP, Beauchamp EC, Alexiades N, Szpilka RT, Anderson RCE. Neonatal Halter Traction for Severe Cervical Spine Deformity: A Technical Case Report With 2-Year Follow-up. Oper Neurosurg (Hagerstown) 2023; 24:e454-e457. [PMID: 36827190 DOI: 10.1227/ons.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Although rare, severe congenital cervical spine deformity can present with limited treatment options and potentially catastrophic outcomes. The use of halter traction for cervical deformity correction in children has been well described, but it has not been previously reported in the management of neonates. CLINICAL PRESENTATION A baby girl born at full-term gestation presented with generalized hypotonia, bilateral club feet, and significant right upper extremity weakness. Imaging demonstrated a severe congenital swan-neck deformity with spinal cord compression. Halter traction was initiated in the neonatal intensive care unit with subsequent neurological and radiographic improvement. After 7 days, traction was discontinued and she was placed in a custom-fitted cervico-thoracic orthosis. At 2 years of follow-up, she remains neurologically stable with maintained cervical alignment. CONCLUSION Halter traction followed by external bracing is technically possible in the neonatal period. For children with severe cervical congenital deformity, this technique can reduce spinal cord compression, provide significant deformity correction, and delay the need for definitive operative spinal stabilization.
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Affiliation(s)
- Richard P Menger
- Department of Neurosurgery, University of South Alabama, Mobile, Alabama, USA
- Department of Political Science, University of South Alabama, Mobile, Alabama, USA
| | | | - Nikita Alexiades
- Department of Neurosurgery, University of Arizona-Phoenix, Phoenix, Arizona, USA
| | | | - Richard C E Anderson
- Neurosurgeons of New Jersey, Ridgewood, New Jersey, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
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Marie-Hardy L, Slimani L, Messa G, El Bourakkadi Z, Prigent A, Sayetta C, Koëth F, Pascal-Moussellard H, Wyart C, Cantaut-Belarif Y. Loss of CSF-contacting neuron sensory function is associated with a hyper-kyphosis of the spine reminiscent of Scheuermann's disease. Sci Rep 2023; 13:5529. [PMID: 37016154 PMCID: PMC10073078 DOI: 10.1038/s41598-023-32536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
Scheuermann's disease, also referred to as Scheuermann's kyphosis, is the second most frequent spine deformity occurring in humans after adolescent idiopathic scoliosis (AIS), both with an unclear etiology. Recent genetic studies in zebrafish unraveled new mechanisms linked to AIS, highlighting the role of the Reissner fiber, an acellular polymer bathing in the cerebrospinal fluid (CSF) in close proximity with ciliated cells and mechanosensory neurons lining the central canal of the spinal cord (CSF-cNs). However, while the Reissner fiber and ciliary beating have been linked to AIS-like phenotypes in zebrafish, the relevance of the sensory functions of CSF-cNs for human spine disorders remains unknown. Here, we show that the thoracic hyper-kyphosis of the spine previously reported in adult pkd2l1 mutant zebrafish, in which the mechanosensory function of CSF-cNs is likely defective, is restricted to the sagittal plane and is not associated with vertebral malformations. By applying orthopedic criteria to analyze the amplitude of the curvature at the apex of the kyphosis, the curve pattern, the sagittal balance and sex bias, we demonstrate that pkd2l1 knock-outs develop a phenotype reminiscent of Scheuermann's disease. Altogether our work consolidates the benefit of combining genetics and analysis of spine deformities in zebrafish to model idiopathic spine disorders in humans.
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Affiliation(s)
- Laura Marie-Hardy
- Orthopedic Surgery and Trauma Center, Pitié-Salpêtrière Teaching Hospital (AP-HP), 47 Boulevard de L'Hôpital, 75013, Paris, France
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Lotfi Slimani
- URP 2496 Laboratory Orofacial Pathologies, Imaging and Biotherapies, Dental School University Paris Cité, and Life Imaging Platform (PIV), Montrouge, France
| | - Giulia Messa
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Zaineb El Bourakkadi
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Annick Prigent
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Celia Sayetta
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Fanny Koëth
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Hugues Pascal-Moussellard
- Orthopedic Surgery and Trauma Center, Pitié-Salpêtrière Teaching Hospital (AP-HP), 47 Boulevard de L'Hôpital, 75013, Paris, France
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France
| | - Claire Wyart
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France.
| | - Yasmine Cantaut-Belarif
- Institut du Cerveau (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université (SU), 75013, Paris, France.
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Vij N, Tolson H, Kiernan H, Agusala V, Viswanath O, Urits I. Pathoanatomy, biomechanics, and treatment of upper cervical ligamentous instability: A literature review. Orthop Rev (Pavia) 2022; 14:37099. [PMID: 35936808 PMCID: PMC9353694 DOI: 10.52965/001c.37099] [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: 01/05/2022] [Accepted: 03/29/2022] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Cervical spine instability broadly refers to compromise of the articular congruity. It can be stratified according to spinal level, functional compromise, and mechanism of instability. Conventional wisdom advocates for use of bracing and physical therapy with only a subset of patients proceeding to obtain surgical treatment. OBJECTIVE The purpose of this review article is to summarize the current state of knowledge on upper cervical ligamentous instability. METHODS The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. RESULTS Many articles report on the etiological factors including ligamentous laxity, traumatic injury, syndrome instability, iatrogenic instability, congenital, and inflammatory causes. A few recent studies elucidate new findings regarding pathoanatomy through the use of finite element analysis. A few articles demonstrate the diagnosis and show that radiographs alone have a low diagnostic rate and that functional MRI may be able to better quantify instability. Conservative treatment has been described, but there are no outcome studies in the literature. Surgical treatment has been described in many different populations with good radiologic and clinical outcomes. Recently the use of preoperative 3D CT reconstruction has been described with radiographic and immediate postoperative patient-reported outcomes. CONCLUSION The presentation of upper cervical spinal instability can be asymptomatic, symptoms of isolated instability, symptoms of nerve irritation, vertebrobasilar insufficiency, or severe neurologic compromise. 3D fine element analysis models and motion-capture systems have the potential to increase our understanding of the pathoanatomic cascade in both traumatic and non-traumatic cases of upper cervical spinal instability. A few modalities on the horizon could increase diagnostic potential. More efforts are needed regarding the use of fine element analysis in understanding the pathoanatomic cascade, the long-term outcomes of children over a spectrum of syndromic causes, and the potential of preoperative virtual simulation to improve surgical outcomes.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix
| | | | | | - Veena Agusala
- Texas Tech University Health Science Center School of Medicine
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
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12
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Dysplasias in the Child’s Spine. Neurosurg Clin N Am 2022; 33:e1-e10. [DOI: 10.1016/j.nec.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Lin Y, Rao S, Liu B, Sun Y, Zhao S, Su G, Chen S, Li Y, Chen B. Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:720. [PMID: 35845524 PMCID: PMC9279768 DOI: 10.21037/atm-22-2282] [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: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses. Case Description The patient in Case 1 presented with neck pain and numbness and weakness in the limbs. The patient in Case 2 presented with numbness in the extremities and the patient in Case 3 presented with bilateral hand numbness and left lower limb weakness. They were all diagnosed with DASM and underwent PFEC1L treatment to maintain the enlargement and decompression of the atlantal canal, which achieved favorable outcomes without complications during the postoperative follow-up visit. Conclusions DASM is rare but potentially dangerous. Its diagnosis is made based on clinical manifestations combined with radiological imaging examinations, especially computed tomography (CT) scan and magnetic resonance imaging (MRI). While C1L is the most common surgical method, PFEC1L is a new feasible and safe therapeutic option with comparable good outcomes and the advantage of being minimally-invasive. To our knowledge this is the first report that PFEC1L was applied for DASM treatment.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Rao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingxin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai Zhao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyi Su
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shudong Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongjin Li
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Singleton M, Ghisi D, Memtsoudis S. Perioperative management in complex spine surgery: a narrative review. Minerva Anestesiol 2022; 88:396-406. [PMID: 35315618 DOI: 10.23736/s0375-9393.22.15933-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The last two decades have seen a significant increase in the number of spine surgical procedures performed worldwide. This type of surgery includes a wide variety of procedures, from mini-invasive discectomies to multi-level spinal arthrodesis and osteotomies. Moreover, different surgical approaches are described at different spine levels: the anesthesiologist should be aware of the potential benefits and risks for the patients and be prepared for their management. In this narrative review we seek to describe basic concepts of perioperative spine care and address evolving areas in which care is changing. We will discuss preoperative concerns, intraoperative management including airway management, choice of maintenance, intraoperative neuromonitoring and anesthetic effect, blood management and the dynamic topic of anesthetic and analgesic techniques. Finally, we will briefly address the issue of perioperative complications as they relate specifically to spine surgery.
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Affiliation(s)
- Michael Singleton
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Daniela Ghisi
- Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, Bologna, Italy -
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.,Department of Public Health, Division of Epidemiology, Weill Cornell Medical College, New York, NY, USA
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15
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Chiapparelli E, Bowen E, Okano I, Salzmann SN, Reisener MJ, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation: An MRI Measurement Analysis. Spine (Phila Pa 1976) 2022; 47:E101-E106. [PMID: 34091562 DOI: 10.1097/brs.0000000000004137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. SUMMARY OF BACKGROUND DATA Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. METHODS We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. RESULT A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. CONCLUSION We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.Level of Evidence: 3.
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16
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Theroux MC, Campbell JW. Anesthetic Concerns of Children With Skeletal Dysplasia. Neurosurg Clin N Am 2021; 33:37-47. [PMID: 34801140 DOI: 10.1016/j.nec.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with skeletal dysplasia present unique challenges for safe anesthetic care including differences in the anatomy of the respiratory system, possibility of cervical spine instability or spinal stenosis, and a unique body habitus. Even seemly routine anesthesia can result in respiratory arrest or spinal cord injury. These complications can largely be avoided by proper planning such as appropriate techniques for the intubation of difficult airways, recognition of cervical instability, neuromonitoring for any anesthesia over an hour in patients with severe spinal stenosis, and preoperative assessment of the trachea and avoidance of neuraxial anesthesia in children with Morquio syndrome.
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Affiliation(s)
- Mary C Theroux
- Department of Anesthesia, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Jeffrey W Campbell
- Division of Pediatric Neurosurgery, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
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17
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Stadler JA. Neurosurgical Evaluation and Management of Patients with Chromosomal Abnormalities. Neurosurg Clin N Am 2021; 33:61-65. [PMID: 34801142 DOI: 10.1016/j.nec.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Patients with chromosomal abnormalities are at risk for numerous neurosurgical pathologies, given the broad impact and multisystem involvement of these disorders. Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13), Klinefelter syndrome (47,XXY), and velocardiofacial or DiGeorge syndrome (22q11.2 deletion) are particularly associated with neurosurgical concerns. Given the heterogeneity of concerns and presentations, these patients benefit from multidisciplinary care provided by teams familiar with their specific syndrome.
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Affiliation(s)
- James A Stadler
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA.
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18
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Schramm D, Freitag N, Nicolai T, Wiemers A, Hinrichs B, Amrhein P, DiDio D, Eich C, Landsleitner B, Eber E, Hammer J. Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology. Respiration 2021; 100:1128-1145. [PMID: 34098560 DOI: 10.1159/000517125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Nicolai
- University Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Anna Wiemers
- Ruhr University Bochum, St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Pediatric Pulmonology, Bochum, Germany
| | - Bernd Hinrichs
- Pediatric Practice Buchholz and Asklepios Medical School Hamburg, Hamburg, Germany
| | - Peter Amrhein
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Diana DiDio
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Bernd Landsleitner
- Department of Anaesthesia and Intensive Care Medicine, Hallerwiese Clinic-Cnopf Children's Hospital, Nuremberg, Germany
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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19
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Classifying vertebral artery anatomy abnormality in children with skeletal dysplasia. Spine Deform 2021; 9:833-839. [PMID: 33403655 DOI: 10.1007/s43390-020-00264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Skeletal dysplasia (SKD) have predictably abnormal occipitocervical skeletal anatomy, but a similar understanding of their vertebral artery anatomy is not known. Knowledge and classification of vertebral artery anatomy in SKD patients is important for safe surgical planning. We aimed to determine if predictably abnormal vertebral artery anatomy exists in pediatric SKD. METHODS We performed a retrospective review of CTAs of the neck for pediatric patients at a single institution from 2006 to 2018. CTAs in SKD and controls were reviewed independently in blinded fashion by two radiologists who classified dominance, vessel curvature at C2, direction at C3, and presence of fenestration and intersegmental artery. RESULTS 14 skeletal dysplasia patients were compared to 32 controls. The path of the vertebral artery at C2 foramen was no different between the cohorts or by side, right (p = 0.43) or left (p = 0.13), nor for medial or lateral exiting direction from C3 foramen on right (p = 0.82) or left (p = 0.60). Dominance was most commonly neutral in both groups (71% in SKD and 63% in controls). There were no fenestrated nor first intersegmental arteries in our cohort. CONCLUSION No systematic differences were detected between SKD and control patients with respect to vertebral artery anatomy. Nonetheless, surgically relevant variability was observed in both groups. Paying particular attention to the direction of exit at C3 and curvature at C2 with respect to the foramen and vessel dominance are important and easily classifiable abnormalities that both surgeons and radiologists can use to communicate and employ in pre-operative planning. LEVEL OF EVIDENCE III.
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20
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Goyal N, Bali S, Ahuja K, Chaudhary S, Barik S, Kandwal P. Posterior Arthrodesis of Atlantoaxial Joint in Congenital Atlantoaxial Instability Under 5 Years of Age: A Systematic Review. J Pediatr Neurosci 2021; 16:97-105. [PMID: 35018176 PMCID: PMC8706584 DOI: 10.4103/jpn.jpn_270_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shivkumar Bali
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sunny Chaudhary
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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21
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Ichinose Y, Kurita T, Satake A, Natori T, Shindo K, Takiyama Y. A patient with ossification of the yellow ligament and ventriculomegaly with 22q11.2 deletion syndrome undiagnosed until adulthood. Heliyon 2020; 6:e05600. [PMID: 33313431 PMCID: PMC7721622 DOI: 10.1016/j.heliyon.2020.e05600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 01/15/2023] Open
Abstract
A 44-year-old female developed mild gait disturbance. She had a history of a ventricular septum defect, deafness, epilepsy, schizophrenia and cataracts. Magnetic resonance imaging showed ventriculomegaly of the brain and lower thoracic spinal stenosis due to ossification of the yellow ligament (OYL). She was diagnosed as having 22q11.2 deletion syndrome (22q11.2DS) by chromosome analysis, and OYL was suspected to be a secondary symptom due to hypoparathyroidism. This is the first report of 22q11.2DS with OYL and ventriculomegaly. Since the present patient was not diagnosed until adulthood, we emphasize that we should keep this common but heterogeneous congenital disease in mind.
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Affiliation(s)
- Yuta Ichinose
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takafumi Kurita
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Akane Satake
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takahiro Natori
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kazumasa Shindo
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi 409-3898, Japan
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Uehara M, Kuraishi S, Ikegami S, Oba H, Takizawa T, Munakata R, Hatakenaka T, Mimura T, Takahashi J. Scoliosis in Goldenhar syndrome with curve reversal during brace treatment: a case report. BMC Musculoskelet Disord 2020; 21:685. [PMID: 33066766 PMCID: PMC7568397 DOI: 10.1186/s12891-020-03719-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
Background Goldenhar syndrome sometimes displays progressive scoliosis and other spinal deformities that require treatment. However, few reports exist on scoliosis correction in Goldenhar syndrome. We described the rare radiological outcomes of a patient with Goldenhar syndrome who received brace treatment for scoliosis. Case presentation A 4-year-old boy was diagnosed as having Goldenhar syndrome and referred to our hospital for scoliosis treatment. The deformity deteriorated gradually, and left convex scoliotic angle was 26 degrees (T3-L2) at 11 years of age. Unexpectedly during treatment with an orthopedic brace, the curve had reversed to 21 degrees (T5-L2) at 7 months of therapy. After another adjustment of the brace, his right convex scoliotic angle improved to 13 degrees (T4-L2) at 15 months of treatment. Conclusions Curve reversal may occur during brace treatment for scoliosis in Goldenhar syndrome. Clinicians may opt to periodically check curve correction despite the risk of increased radiation exposure.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Shugo Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takashi Takizawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ryo Munakata
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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24
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Ma X, Wang B, Yang J, Xia H, Wang G, Wang W, Wang J. One-Stage Anteroposterior Extensive Atlantoaxial Osteotomy Correction With 16 Months Follow-up: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E190-E195. [PMID: 31828342 DOI: 10.1093/ons/opz382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/07/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Patients with severe thoracic or lumbar deformities can achieve satisfactory correction through appropriate osteotomies. However, patients with multiple craniocervical malformations commonly undergo conservative or finite surgical therapy mainly because of the involvement of the vertebral artery. Anterior oral meningocele is an extremely rare pathology that has not been previously reported. Here, we provide the first report of complex craniocervical anomalies combined with oral meningocele treated with a 1-stage anteroposterior atlantoaxial osteotomy correction surgery, with outcomes after 16 mo follow-up. CLINICAL PRESENTATION A 10-yr-old boy presented with recurrent dyspnea, cyanosis, and progressive torticollis. Imaging studies revealed complicated bony abnormalities accompanied by an anterior oral meningocele. A 1-stage extensive atlantoaxial osteotomy through anterior and posterior approaches was performed with an innovatively designed vertebral artery exclusion technique. Lumbar cistern drainage and ceftazidime were used to address the leakage of cerebrospinal fluid and intracranial infection. CONCLUSION The satisfactory outcome demonstrates the feasibility of extensive atlantoaxial osteotomy via a vertebral artery exclusion technique that might also be applicable to osteotomy in segments of C3-C6.
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Affiliation(s)
- Xiangyang Ma
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Binbin Wang
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Jincheng Yang
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Hong Xia
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Guoliang Wang
- Department of Neurosurgery, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Weijian Wang
- Department of Stomatology, Liuhua Qiao Hospital, Guangzhou Shi, China
| | - Jian Wang
- Department of Otolaryngology, Liuhua Qiao Hospital, Guangzhou Shi, China
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Reduction Mammaplasty in a Patient with Kniest Dysplasia: Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2649. [PMID: 32537328 PMCID: PMC7253254 DOI: 10.1097/gox.0000000000002649] [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: 07/11/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Collagen plays a fundamental role in wound healing and consequently defective collagen can impair normal wound healing processes. Kniest dysplasia (KD) is a collagenopathy that results from a pathogenic mutation in a gene that codes for type II collagen. Clinical manifestations of the dysplasia include short-trunk dwarfism, kyphoscoliosis, hand arthropathy, cleft palate, hearing loss, and ocular abnormalities. We present the case of a 21-year-old woman who desired reduction mammaplasty. A review of the literature was performed, and there were no published reports of any plastic surgery procedures in patients with KD. The patient proceeded with surgery and healed without any complications. Given that wound healing appears normal in this patient population, it is reasonable to consider elective plastic surgical procedures in patients with KD.
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Pathological Features and Surgical Strategies of Cervical Deformity. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4290597. [PMID: 32461987 PMCID: PMC7243010 DOI: 10.1155/2020/4290597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/28/2020] [Indexed: 01/15/2023]
Abstract
Cervical deformity (CD) is a kind of disorder influencing cervical alignment. Although the incidence of CD is not high, this deformity can cause not only pain but also difficulties in daily activities such as swallowing and maintaining upright position. Even though the common cause of cervical deformity is still controversial, previous studies divided CD into congenital deformity and secondary deformity; secondary deformity includes iatrogenic and noniatrogenic deformity according to pathogenic factors. Due to the lack of relevant studies, a standardized evaluation for CD is absent. Even though the assessment of preoperative condition and surgical planning mainly rely on personal experience, the evaluation methods could still be summarized from previous studies. The objective in this article is to summarize studies on cervical scoliosis, identify clinical problems, and provide directions for researchers interested in delving deep into this specific topic. In this review, we found that the lack of standard classification system could lead to an absence of clinical guidance; in addition, the osseous landmarks and vascular distributions could be variable in CD patients, which might cause the risk of vascular or neurological complications; furthermore, multiple deformities were usually presented in CD patients, which might cause chain reaction after the correction of CD; this would prevent surgeons from choosing realignment surgery that is effective but risky.
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Villa EK, Villa D, Bundoc RC. Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion. BMJ Case Rep 2020; 13:13/2/e231276. [PMID: 32051155 DOI: 10.1136/bcr-2019-231276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.
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Affiliation(s)
- Evangeline Ko Villa
- Department of Anesthesiology Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Dominic Villa
- Department of Anesthesiology Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rafael C Bundoc
- Department of Orthopedics Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Zhang J, Lu Y, Wang Y, Li T, Peng C, Zhang S, Gao Q, Li W, Liu C, Han J. Health assessment of patients with achondroplasia, pseudoachondroplasia, and rickets based on 3D non-linear diagnostics. Intractable Rare Dis Res 2020; 9:35-39. [PMID: 32201673 PMCID: PMC7062601 DOI: 10.5582/irdr.2020.01019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The goal of this study was to analyze diminishment of the functional status of the skeleton, parts of organs, regions of the brain, connective tissues, and chondrocytes in patients with achondroplasia (ACH), pseudoachondroplasia (PSACH), and rickets. Three-dimensional non-linear scanning (3D-NLS) was used to analyze the functional status of patients with genetic bone disorders, including 7 patients with ACH, 3 patients with PSACH, and 3 patients with rickets. Results indicated that the percentage of patients with long bones in the decompensatory phase did not differ depending on whether they had ACH, PSACH, or rickets. Joints in the decompensatory phase did not differ in patients with ACH except for the right hip (16.67%). Various joints were in the decompensatory phase (16.7-33.3%) in patients with rickets. The thoracic vertebrae, lumbar vertebrae, and liver were in the decompensatory phase in all 3 groups of patients. Connective tissues were in the decompensatory phase in 33.33% of patients with ACH. None of the patients with PSACH had chondrocytes in the decompensatory phase but 66.67% of patients with ACH or rickets did. Regions of the brain in the decompensatory phase were most prevalent in patients with rickets or ACH but not in patients with PSACH. In conclusion, diagnosis based on 3D-NLS was able to identify the functional status of genetic bone disorders. Some areas of decompensation were common to the 3 diseases studied but other areas were specific to a given disease.
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Affiliation(s)
- Jian Zhang
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Ji'nan, China
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Yanqin Lu
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Ji'nan, China
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
- Address correspondence to:Yanqin Lu and Jinxiang Han, Shandong First Medical University & Shandong Academy of Medical Sciences, 18877 Jingshi Road, Ji'nan, China 250062. E-mail: ,
| | - Yanzhou Wang
- Shandong Provincial Hospital Affiliated with Shandong First Medical University, Ji'nan, China
| | - Tianyou Li
- Shandong Provincial Hospital Affiliated with Shandong First Medical University, Ji'nan, China
| | - Chuanming Peng
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Ji'nan, China
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Shie Zhang
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Ji'nan, China
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Qingxia Gao
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Wei Li
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Chunshang Liu
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
| | - Jinxiang Han
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Ji'nan, China
- Key Laboratory for Biotech Drugs of the National Health Commission, Key Laboratory for Rare & Uncommon Diseases of Shandong Province, Shandong Medicinal Biotechnology Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Ji'nan, China
- Address correspondence to:Yanqin Lu and Jinxiang Han, Shandong First Medical University & Shandong Academy of Medical Sciences, 18877 Jingshi Road, Ji'nan, China 250062. E-mail: ,
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Cohen LL, Yang BW, O'Neill NP, Proctor MR, Glotzbecker MP, Hedequist DJ. Use of recombinant human bone morphogenetic protein for revision cervical spine fusion in children with Down syndrome: a case series. J Neurosurg Pediatr 2020; 25:535-539. [PMID: 32005018 DOI: 10.3171/2019.11.peds19622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with trisomy 21 (Down syndrome; DS) often have atlantoaxial instability (AAI), which, if severe, causes myelopathy and neurological deterioration. Children with DS and AAI who undergo cervical spine fusion have a high rate of nonunion requiring revision surgery. Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a TGF-β growth factor that is used to induce bone formation in spine fusion. Although previous studies in the adult population have reported no reduction in pseudarthrosis rates with the use of rhBMP-2, there is a lack of literature in the pediatric DS population. This study describes the use of rhBMP-2 in children with DS and AAI during revision to treat nonunion. METHODS A retrospective review of a cervical spine fusion database (n = 175) was conducted. This database included all cervical spine fusions using modern instrumentation at the authors' institution from 2002 to 2019. Patients with DS who underwent a revision utilizing rhBMP-2 were included in the study. The number of prior fusions, use of rhBMP-2 in fusions, length of stay, halo use, and surgical data were collected. Postoperative complications and length of follow-up were also recorded. RESULTS Eight patients (75% female) met the inclusion criteria. The average age at revision with rhBMP-2 was 11 years (range 3-19 years). All patients were diagnosed with nonunion after an initial cervical fusion. All revisions were posterior fusions of C1-2 (n = 2) or occiput to cervical (n = 6). All revisions included implant revisions, iliac crest bone grafting, and rhBMP-2 use. One patient required irrigation and debridement of an rhBMP-induced seroma. Another patient required return to the operating room to repair a dural tear. There were no neurological, infectious, airway, or implant-related complications. Revision utilizing rhBMP-2 achieved fusion in 100% (n = 8) of patients. The average length of follow-up was 42.6 months. All patients demonstrated solid fusion mass on the last radiograph. CONCLUSIONS This is the first case series reporting the successful use of rhBMP-2 to facilitate cervical spine fusion in patients with DS after previous nonunion. In addition, few rhBMP-2-related postoperative complications occurred.
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Affiliation(s)
| | | | | | - Mark R Proctor
- 2Neurosurgery, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
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Occiput-to-Pelvis Spinal Arthrodesis: A Case Series. Spine Deform 2019; 7:992-1002. [PMID: 31732013 DOI: 10.1016/j.jspd.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To describe the indications, operative course, and outcomes in eight pediatric patients who underwent occiput-to-pelvis (O-P) spinal arthrodesis. SUMMARY Spinal arthrodesis from the occiput to pelvis is needed for some children with extensive spine deformity. There are few reports of patients with O-P arthrodesis. METHODS We reviewed records of pediatric patients who underwent spinal arthrodesis to treat spine deformity between 1987 and 2017 at one institution. Eight patients (six girls) who underwent staged O-P arthrodesis were identified. Underlying conditions, indications for surgery, medical comorbidities, operative courses, complications, and imaging of these patients were recorded. RESULTS Diagnoses were neuromuscular disorders in five patients and syndromic disorders in three patients. Mean ages were 9.7 ± 4.1 years at index surgery and 16.8 ± 4.6 years at completion of O-P arthrodesis. Patients underwent a mean of three operations (range, two to five). Occipitocervical arthrodesis was the final operation in six of eight patients (all but the two patients with Loeys-Dietz syndrome). Mean follow-up after the last procedure was 8.5 ± 7.1 years. Two patients underwent revision for protruding occipital implants, and one patient underwent revision for thoracic pseudarthrosis. No patients developed postoperative infections or new neurologic deficits. At final follow-up, Scoliosis Research Society-22r questionnaire scores were lowest for Function (2.6 ± 1.0 of 5 possible points) and highest for Satisfaction (4.1 ± 1.4). CONCLUSIONS O-P arthrodesis can benefit patients with extensive spine deformity from neuromuscular or syndromic causes. Patients were young at first operation, which may suggest that younger patients are at higher risk than older patients of major progression of deformity in other spinal regions after deformity correction. Health-related quality of life and radiographic outcomes suggest that patients who underwent O-P arthrodesis had satisfactory outcomes and maintenance of correction during a mean of 8.5 years of follow-up. LEVEL OF EVIDENCE Level IV, therapeutic study.
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[Dysphagia in cervical spine diseases]. HNO 2019; 67:801-814. [PMID: 31485696 DOI: 10.1007/s00106-019-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dysphagia is a common symptom and can be indicative of a variety of heterogeneous diseases. "Classical" diseases of the head and neck region, such as acute tonsillitis, peritonsillar abscesses, diverticula, and benign or malignant tumors are common causes of dysphagia. However, it can also occur in the context of neurological diseases, e.g., as a result of stroke or as an age-related phenomenon (presbyphagia). Pathologies of the cervical spine can also be a cause of dysphagia. In this context, congenital or acquired diseases, inflammatory or degenerative processes, cervical spine surgery, and (malignant) masses of the cervical spine should be taken into account. Particular dysphagia with a positive history of previous operative interventions on the cervical spine or symptoms such as chronic back pain and trauma should give rise to consideration of a cervical spine-related cause.
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Mueller K, MacConnell A, Berkowitz F, Voyadzis JM. Morphological classification of the tubercle of insertion of the transverse atlantal ligament: A computer tomography-based anatomical study of 200 subjects. Neuroradiol J 2019; 32:426-430. [PMID: 31290720 DOI: 10.1177/1971400919857211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE The atlantal tubercle is the attachment point of the transverse atlantal ligament, the main stabilizer of the atlantoaxial complex. No system of classification of the tubercle exists in the literature. We aimed to develop a morphologically based classification system of the atlantal tubercle to aid clinicians who deal with craniocervical pathology. MATERIALS AND METHODS A retrospective review of computed tomography (CT) scans of the cervical spine was performed. The morphology of the atlantal tubercle was classified into four variants: rounded (classical), pointed, flattened, and hypoplastic. Age, presence, and morphological type were recorded. RESULTS A total of 200 CT scans were identified and reviewed. The tubercle was present bilaterally in all patients. Patients were equally distributed over various age ranges. The following morphological types were recorded: rounded (227/400; 56.8%), pointed (13/400; 3.3%), flattened (126; 31.5%), and hypoplastic (34/400; 8.5%). The same type was seen bilaterally in 68% (135/200) of patients. Morphological types appear equally on the right and left side of the atlas. CONCLUSIONS The first morphologically based classification system of the atlantal tubercle utilizing CT is presented. Morphology type, especially hypoplastic type, may confer an increased risk for subsequent need for posterior fusion.
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Affiliation(s)
- Kyle Mueller
- Department of Neurosurgery, Medstar Georgetown University Hospital, USA
| | | | - Frank Berkowitz
- Department of Neuroradiology, Medstar Georgetown University Hospital, USA
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Abu-Ghname A, Masoumy M, Monson LA. Cervical Stenosis in Non-Syndromic Pierre Robin Sequence. J Craniofac Surg 2019; 30:1866-1868. [PMID: 31283644 DOI: 10.1097/scs.0000000000005727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pierre Robin sequence is a triad of micrognathia, glossoptosis, and airway obstruction that has reported associations with numerous birth defects and anomalies including craniocervical pathologies. Given the number of airway assessments and neck manipulations these neonates experience, undetected cervical instability can result in detrimental consequences. The authors present a case of a neonate with non-syndromic Pierre Robin sequence planned for mandibular distraction osteogenesis that developed abnormal motor activity following intubation. The patient was eventually diagnosed with cervical spine stenosis and craniocervical instability after radiologic investigation. This paper demonstrates the significance of preoperative cervical spine evaluation and the importance of maintaining high level of suspicion when performing neck manipulations in those high-risk infants.
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Affiliation(s)
- Amjed Abu-Ghname
- Division of Plastic Surgery at Texas Children's Hospital/ Michael E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, TX
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Al Kaissi A, Ryabykh S, Pavlova OM, Ochirova P, Kenis V, Chehida FB, Ganger R, Grill F, Kircher SG. The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita: Observational study. Medicine (Baltimore) 2019; 98:e13780. [PMID: 30608389 PMCID: PMC6344193 DOI: 10.1097/md.0000000000013780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Cervical spine radiographs showed apparent atlantoaxial instability in correlation with odontoid hypoplasia or os-odontoideum.Instability of 8 mm or more and or the presence of symptoms of myelopathy were the main indications for surgery. Posterior cervical fusion from the occiput or C1-3, decompression of C1-2 and application of autorib transfer followed by halo vest immobilization have been applied accordingly.Orthopedic management of children with spondyloepiphyseal dysplasia congenita (SEDC) should begin with the cervical spine to avoid serious neurological deficits and or mortality.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and, AUVA TraumaCentre Meidling, First Medical Department, Hanusch Hospital
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
| | - Sergey Ryabykh
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Olga M. Pavlova
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Polina Ochirova
- Division Spine Pathology and Rare Diseases, Russian Scientific Ilizarov Center, Kurgan, Russia
| | - Vladimir Kenis
- Pediatric Orthopedic Institute n.a. H. Turner, Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Saint-Petersburg, Russia
| | | | - Rudolf Ganger
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
| | - Franz Grill
- Orthopaedic Hospital of Speising- Pediatric Department, Vienna, Austria
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Lee H, Kim JS, Lim SH, Sul B, Hong BY. Cervical Spine Malformations Associated With a 5q34-5q35.2 Micro-interstitial Deletion: A Case Report. Ann Rehabil Med 2018; 42:884-887. [PMID: 30613082 PMCID: PMC6325309 DOI: 10.5535/arm.2018.42.6.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/12/2018] [Indexed: 11/05/2022] Open
Abstract
We report a female proband carrying a de novo 5q34-q35.2 deletion breakpoint, and review the unique skeletal phenotype and possible genotype related to this mutation. The patient presented with a persistent head tilt and limited head rotation. Non-contrast-enhanced three-dimensional computed tomography of the cervical spine revealed several malformations including a bone cleft in the right pars interarticularis, a bone defect in both C5 lamina and the transverse foramen at C2-C3, agenesis of the right articular process of C5, bony fusion of C4-C5, and subluxation of the craniocervical joints. Several deformities of the cervical spine seen in this patient have not been associated with the 5q deletion. A review of 5q-related mutations suggests that abnormalities associated with MSX2 gene might cause cervical spine abnormalities.
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Affiliation(s)
| | | | | | | | - Bo Young Hong
- Corresponding author: Bo Young Hong Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: +82-31-249-7650, Fax: +82-31-251-4481, E-mail:
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Fatal atlantoaxial dislocation due to an odontoid synchondrosis fracture in a child with chromosome 9 abnormality: A case report. J Forensic Leg Med 2018; 61:92-96. [PMID: 30528850 DOI: 10.1016/j.jflm.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/07/2018] [Accepted: 11/22/2018] [Indexed: 11/20/2022]
Abstract
A 5-year-old boy with a chromosome-9 abnormality and multiple external and visceral malformations was found in cardiopulmonary arrest during a regular visit to the hospital; he did not respond to cardiopulmonary resuscitation and died. An odontoid process fracture and calcification and fibrosis of the muscles around the superior cervical vertebra were observed during the autopsy. Postmortem computed tomography revealed an anterior dislocation of the atlas; odontoid synchondrosis fracture; and delayed, incomplete bony fusion of the odontoid process relative to his age. The cause of his death was a superior spinal cord injury. The tissue surrounding the upper cervical spine presented with myositis ossificans, suggesting a prior injury. He experienced a minor traffic accident 3 months before his death. It was concluded that the odontoid synchondrosis fracture occurred during the accident based on the incomplete bony fusion and atlantoaxial instability, which were consistent with the findings of myositis ossificans. Delayed fatal dislocation may then have occurred under the influence of a minor external force. Odontoid process abnormalities and atlantoaxial instability are common in patients with trisomy 21 and other congenital diseases; however, the condition's association with chromosome-9 abnormalities has not been reported. In children with various chromosomal abnormalities, periodic assessment of instability and morphology of the cervical spine, and a lowered examination threshold for the children at risk, could prove useful in the prevention injuries leading to fatality, and provide additional information to rule out abuse.
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Hofler RC, Heiferman DM, Molefe A, LeDuc R, Johans SJ, Rosenblum JD, Nockels RP, Jones GA. Morphologic variations of the second cervical vertebra in Down syndrome compared with age-matched peers. J Neurosurg Spine 2018; 30:175-181. [PMID: 30497148 DOI: 10.3171/2018.8.spine18750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAtlantoaxial instability is an important cause of pain and neurological dysfunction in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. This study provides a quantitative analysis of C2 morphology in DS patients compared with their peers without DS to identify differences that must be considered for the safe placement of instrumentation.METHODSA retrospective chart review identified age-matched patients with and without DS with a CT scan of the cervical spine. Three-dimensional reconstructions of these scans were made with images along the axis of, and perpendicular to, the pars, lamina, facet, and transverse foramen of C2 bilaterally. Two of the authors performed independent measurements of anatomical structures using these images, and the average of the 2 raters' measurements was recorded. Pedicle height and width; pars axis length (the distance from the facet to the anterior vertebral body through the pars); pars rostrocaudal angle (angle of the pars axis length to the endplate of C2); pars axial angle (angle of the pars axis length to the median coronal plane); lamina height, length, and width; lamina angle (angle of the lamina length to the median coronal plane); and transverse foramen posterior distance (the distance from the posterior wall of the transverse foramen to the tangent of the posterior vertebral body) were measured bilaterally. Patients with and without DS were compared using a mixed-effects model accounting for patient height.RESULTSA total of 18 patients with and 20 patients without DS were included in the analysis. The groups were matched based on age and sex. The median height was 147 cm (IQR 142-160 cm) in the DS group and 165 cm (IQR 161-172 cm) in the non-DS group (p < 0.001). After accounting for variations in height, the mean pars rostrocaudal angle was greater (50.86° vs 45.54°, p = 0.004), the mean transverse foramen posterior distance was less (-1.5 mm vs +1.3 mm, p = 0.001), and the mean lamina width was less (6.2 mm vs 7.7 mm, p = 0.038) in patients with DS.CONCLUSIONSPatients with DS had a steeper rostrocaudal trajectory of the pars, a more posteriorly positioned transverse foramen posterior wall, and a narrower lamina compared with age- and sex-matched peers. These variations should be considered during surgical planning, as they may have implications to safe placement of instrumentation.
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Affiliation(s)
| | | | - Ayrin Molefe
- 2Clinical Research Office, Loyola University Chicago Health Sciences Division, Chicago; and
| | - Ryan LeDuc
- 3Stritch School of Medicine, Loyola University Chicago, Illinois
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Peracha H, Sawamoto K, Averill L, Kecskemethy H, Theroux M, Thacker M, Nagao K, Pizarro C, Mackenzie W, Kobayashi H, Yamaguchi S, Suzuki Y, Orii K, Orii T, Fukao T, Tomatsu S. Molecular genetics and metabolism, special edition: Diagnosis, diagnosis and prognosis of Mucopolysaccharidosis IVA. Mol Genet Metab 2018; 125:18-37. [PMID: 29779902 PMCID: PMC6175643 DOI: 10.1016/j.ymgme.2018.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/03/2023]
Abstract
Mucopolysaccharidosis IVA (MPS IVA, Morquio A syndrome) is an autosomal recessive disorder caused by the deficiency of N-acetylgalactosamine-6-sulfate sulfatase. Deficiency of this enzyme leads to the accumulation of specific glycosaminoglycans (GAGs), chondroitin-6-sulfate (C6S) and keratan sulfate (KS), which are mainly synthesized in the cartilage. Therefore, the substrates are stored primarily in the cartilage and its extracellular matrix (ECM), leading to a direct impact on bone development and successive systemic skeletal spondylepiphyseal dysplasia. The skeletal-related symptoms for MPS IVA include short stature with short neck and trunk, odontoid hypoplasia, spinal cord compression, tracheal obstruction, obstructive airway, pectus carinatum, restrictive lung, kyphoscoliosis, platyspondyly, coxa valga, genu valgum, waddling gait, and laxity of joints. The degree of imbalance of growth in bone and other organs and tissues largely contributes to unique skeletal dysplasia and clinical severity. Diagnosis of MPS IVA needs clinical, radiographic, and laboratory testing to make a complete conclusion. To diagnose MPS IVA, total urinary GAG analysis which has been used is problematic since the values overlap with those in age-matched controls. Currently, urinary and blood KS and C6S, the enzyme activity of GALNS, and GALNS molecular analysis are used for diagnosis and prognosis of clinical phenotype in MPS IVA. MPS IVA can be diagnosed with unique characters although this disorder relates closely to other disorders in some characteristics. In this review article, we comprehensively describe clinical, radiographic, biochemical, and molecular diagnosis and clinical assessment tests for MPS IVA. We also compare MPS IVA to other closely related disorders to differentiate MPS IVA. Overall, imbalance of growth in MPS IVA patients underlies unique skeletal manifestations leading to a critical indicator for diagnosis.
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Affiliation(s)
- Hira Peracha
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Kazuki Sawamoto
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Lauren Averill
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Heidi Kecskemethy
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Mary Theroux
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mihir Thacker
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Kyoko Nagao
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Linguistics and Cognitive Science, University of Delaware, Newark, DE, United States; College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Christian Pizarro
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - William Mackenzie
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | | | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University, Shimane, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University, Japan
| | - Kenji Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tadao Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shunji Tomatsu
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States; Department of Pediatrics, Shimane University, Shimane, Japan; Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan.
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The Outcomes of Posterior Arthrodesis for Atlantoaxial Subluxation in Down Syndrome Patients: A Meta-Analysis. Clin Spine Surg 2018; 31:300-305. [PMID: 29847415 DOI: 10.1097/bsd.0000000000000658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a meta-analysis. OBJECTIVE To establish rates of (1) neurological complications, (2) bony-related complications, (3) complications delaying recovery, (4) reoperation, and (5) fatalities following posterior cervical arthrodesis in Down syndrome (DS) patients with atlantoaxial subluxation. To determine if presenting symptoms had any relationship to postoperative complications. SUMMARY OF BACKGROUND DATA Posterior arthrodesis is commonly utilized to correct cervical instability secondary to atlantoaxial instability in DS patients. However, there has never been a global evaluation of postoperative complications associated with posterior cervical spinal arthrodesis in DS patients. METHODS A comprehensive search of Medline/PubMed, EMBASE, and Ovid databases between January 1980 and July 2017 was utilized to identify DS patients with atlantoaxial subluxation who underwent posterior cervical arthrodesis. Data were sorted by neurological complications, complications delaying recovery, bony-related complications, reoperations, and fatalities. Patients were sorted into 2 groups based on presentation with or without neurological deficits. RESULTS Twelve studies met inclusion criteria, including 128 DS patients. Mean age was 13.8 years (range: 6.7-32.7 y; 47.8% male). Mean follow-up was 31.7 months (range: 14.9-77 mo). All patients underwent primary posterior cervical arthrodesis with an average of 2.5 vertebrae fused. A total of 39.6% of patients had bony-related complications [95% confidence interval (CI), 31.4%-48.5%], 23.3% had neurological deficits (95% CI, 16.6%-31.6%), and 26.4% experienced complications delaying recovery (95% CI, 19.4%-34.9%). The reoperation rate was 34.9% (95% CI, 25.5%-45.6%). The mortality rate was 3.9% (95% CI, 1.5%-9.7%). Neurological complications were 4-fold (P<0.05) and reoperation was 5.5-fold (P<0.05) more likely in patients presenting with neurological deficits compared with those without. CONCLUSIONS This study detailed global complication rates of posterior arthrodesis for DS patients, identifying bony-related complications and reoperations among the most common. Patients presenting with neurological symptoms and cervical instability have increased postoperative rates of neurological complications and reoperations than patients with instability alone. Further investigation into how postoperative complications effect patient independence is warranted.
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Pavlova OM, Ryabykh SO, Burcev AV, Gubin AV. Anomaly-Related Pathologic Atlantoaxial Displacement in Pediatric Patients. World Neurosurg 2018; 114:e532-e545. [DOI: 10.1016/j.wneu.2018.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
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Hasegawa-Moriyama M, Iwasaki T, Mukaihara K, Masuda M, Kanmura Y. Unsuccessful tracheal intubation in a patient with Kniest dysplasia undergoing repeated general anesthesia: a case report. JA Clin Rep 2018; 4:41. [PMID: 32025981 PMCID: PMC6966974 DOI: 10.1186/s40981-018-0178-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background Kniest dysplasia is a type of chondrodysplasia characterized by severe craniofacial abnormalities including tracheomalacia, midface hypoplasia, and cleft palate. Case presentation We previously described a 6-year-old girl with Kniest dysplasia, in whom glottic edema rapidly developed after tracheal intubation. At the age of 13 years, a reoperation was scheduled to correct talipes equinovarus but was subsequently canceled due to failure of tracheal intubation and subsequent glottic edema. Airway evaluation by endoscopy and computed tomography 1 month later revealed severe laryngeal narrowing. Therefore, the second anesthesia was maintained with spinal anesthesia combined with sciatic nerve block without tracheal intubation. Conclusion Careful perioperative airway evaluation is required in patients with Kniest dysplasia, and alternative strategies for airway management other than tracheal intubation should be considered.
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Affiliation(s)
- Maiko Hasegawa-Moriyama
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Keika Mukaihara
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Mina Masuda
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuichi Kanmura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Farah K, Pech-Gourg G, Graillon T, Scavarda D, Fuentes S. A New Minimally Invasive Technique for Primary Unstable C2 Spondylolysis in an 8-Year-Old Child: A Case Report and Review of the Literature. World Neurosurg 2018; 115:79-84. [PMID: 29654954 DOI: 10.1016/j.wneu.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posterior arch defect of C2 with an unstable spondylolysis is a rare condition mostly occurring within children. Its management is still controversial. CASE DESCRIPTION We report in this article the first minimally invasive surgery (MIS) technique for this condition in an 8-year-old boy. A primary unstable C2 spondylolysis was diagnosed on the exploration of episodic paresthesia of upper limbs associated with headache lasting for several months. The surgical technique consisted in a direct pars repair through an MIS approach: METRx tubular retractor system (Medtronic Sofamor Danek, Memphis, Tennessee, USA), intraoperative C-arm fluoroscopy, surgical microscope, endoscopic spine instrument, and high-speed drill were required. Muscles were split and retracted. One-year postoperative course was excellent. CONCLUSIONS After reviewing the past literature of this pathology, we discuss the minimally invasive posterior approach of the upper cervical spine. It is the first case, to our knowledge, describing direct minimally invasive repair for bilateral primary C2 pars defect in a child. Image guidance and surgical microscope help safe and effective screw placement.
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Affiliation(s)
- Kaissar Farah
- Department of Neurosurgery, La Timone, University Hospital, Marseille, France.
| | - Gregoire Pech-Gourg
- Department of Pediatric Neurosurgery, La Timone Enfants, University Hospital, Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, La Timone, University Hospital, Marseille, France
| | - Didier Scavarda
- Department of Pediatric Neurosurgery, La Timone Enfants, University Hospital, Marseille, France
| | - Stephane Fuentes
- Department of Neurosurgery, La Timone, University Hospital, Marseille, France
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Yamaguchi S, Mitsuhara T, Abiko M, Takeda M, Kurisu K. Epidemiology and Overview of the Clinical Spectrum of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:1-12. [DOI: 10.1016/j.nec.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques. DATA SOURCES Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia. RESULTS The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed. CONCLUSIONS Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
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Abstract
Many patients with Pierre Robin sequence (PRS) have associated birth defects, most commonly in association with abnormalities in bone or cartilage formation. Depending on severity, treatment of PRS ranges from nonoperative management with prone positioning to surgical intervention such as distraction osteogenesis. Generally, if a surgical approach is needed, these patients undergo nasal endoscopy or direct laryngoscopy with their intubation, which puts the cervical spine in a position of extreme extension. The authors present a patient with syndromic PRS secondary to Sticklers syndrome, with a cervical abnormality diagnosed with three-dimensional computed tomography and further evaluated with dynamic lateral plain x-rays to assess cervical instability. The goal of this report is to highlight the need to include cervical spine evaluation in the preoperation workup of patients with PRS, especially those with suspected abnormalities in bone or collagen formation.
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Sardi JP, Iwanaga J, Oskouian RJ, Tubbs RS. First Gross Anatomic Findings of an Os Odontoideum. World Neurosurg 2017; 101:813.e1-813.e3. [PMID: 28344179 DOI: 10.1016/j.wneu.2017.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Os odontoideum is an uncommon abnormality of the craniovertebral junction where the tip of the odontoid process lacks continuity with the body of C2. The clinical presentation is variable, but severe neurologic impairment can result. CASE DESCRIPTION We report the gross and radiologic findings of a cadaver found to harbor an os odontoideum. CONCLUSIONS To our knowledge, there are no cadaveric reports in the literature regarding an os odontoideum. Such a case allows a rare window into the anatomy and relationships of this pathologic structure.
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Affiliation(s)
- Juan P Sardi
- Department of Neurological Surgery, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies
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Wagner MW, Poretti A, Benson JE, Huisman TAGM. Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review. J Neuroimaging 2016; 27:162-209. [PMID: 28000960 DOI: 10.1111/jon.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed. Sensitive and specific identification of CNS lesions while evaluating a child with a GSD requires a detailed knowledge of the possible associated CNS abnormalities. Here, we provide a pattern-recognition approach for neuroimaging findings in GSDs guided by the obvious skeletal manifestations of GSD. In particular, we summarize which CNS findings should be ruled out with each GSD. The diseases (n = 180) are classified based on the skeletal involvement (1. abnormal metaphysis or epiphysis, 2. abnormal size/number of bones, 3. abnormal shape of bones and joints, and 4. abnormal dynamic or structural changes). For each disease, skeletal involvement was defined in accordance with Online Mendelian Inheritance in Man. Morphological CNS involvement has been described based on extensive literature search. Selected examples will be shown based on prevalence of the diseases and significance of the CNS involvement. CNS involvement is common in GSDs. A wide spectrum of morphological abnormalities is associated with GSDs. Early diagnosis of CNS involvement is important in the management of children with GSDs. This pattern-recognition approach aims to assist and guide physicians in the diagnostic work-up of CNS involvement in children with GSDs and their management.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane E Benson
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Silva LECTD, Barros AGCD, Cavalcanti LR, Castro CJD, Tavares RH, Souza RTD. RESULTS OF SURGICAL TREATMENT IN THE CRANIOCERVICAL JUNCTION IN MUCOPOLYSACCHARIDOSIS. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161501153519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
ABSTRACT Objective: Evaluate the results after decompression and stabilization of craniocervical junction in patients with mucopolysaccharidosis (MPS). Method: Retrospective study of 10 patients with MPS through the analysis of medical records and additional tests. Result: All patients with mid-term and long-term follow-up achieved consolidation of the arthrodesis and 87.5% had neurological improvement of Nurick score. Conclusion: Early diagnosis and intervention in cases of stenosis and/or craniocervical instability of patients with MPS provide patients a good recovery of neurological function, despite the great technical difficulty and risk of complications.
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Nicolai T, Schramm D, Hammer J, Eber E, Eich CB, Hinrichs B. Bronchoskopie bei Kindern. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0046-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Buyukkaya A, Özel MA, Onbas Ö. Cervical involvement in Morquio syndrome. Spine J 2015; 15:e7. [PMID: 26096480 DOI: 10.1016/j.spinee.2015.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Ayla Buyukkaya
- Department of Radiology, Duzce Ataturk Government Hospital, Duzce, Turkey
| | - Mehmet Ali Özel
- Department of Radiology, School of Medicine, Duzce University, Konuralp, Duzce, Turkey
| | - Ömer Onbas
- Department of Radiology, School of Medicine, Duzce University, Konuralp, Duzce, Turkey
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