Developmental orthopaedics. II: The spine, trauma and infection

Effects of cervical deep muscle strengthening in a neck pain: a patient with klippel-feil syndrome

[Purpose] This study aimed to identify the effects of cervical deep muscle strengthening (CDS) on neck pain in a patient with Klippel-Feil syndrome (KFS). [Subjects and Methods] The subjects was a 39 year-old woman with neck pain and KFS that included incomplete block vertebrae in the C2–3 segments and block vertebrae in the C6–7 segments. The subject performed an exercise program including cervical strengthening exercise (level 1) and CDS exercise (level 2) for 6 weeks. Neck pain intensity was measured using the visual analogue scale (VAS) and the pressure pain threshold (PPT). All measurements were obtained before and after the CDS exercise program. [Results] The VAS and PPT measurements decreased; range of motion in the cervical joint increased. [Conclusion] CDS exercises were effective interventions for reducing neck pain in a patient with Klippel-Feil syndrome.

Radiographic assessment of segmental motion at the atlantoaxial junction in the Klippel-Feil patient

STUDY DESIGN

A retrospective review of 33 consecutive Klippel-Feil syndrome (KFS) patients at a single institution.

OBJECTIVES

To assess in KFS patients the presence and degree of radiographic segmental motion at the atlantoaxial junction, factors contributing to such motion, and associated clinical manifestations.

SUMMARY OF BACKGROUND DATA

Studies suggest that abnormal segmentation in KFS patients may result in cervical hypermobility, increasing the risk of developing neurologic compromise and the need for surgical intervention. The use of the anterior and posterior atlantodens interval (AADI/PADI) has gained interest as a method for assessing atlantoaxial instability and for space available for the cord. Although helpful for identifying instability after trauma, these measurements are not understood in KFS patients. In addition, the effects of the fusion process associated with KFS on atlantoaxial motion and associated clinical findings have not been properly addressed.

METHODS

Radiographs were analyzed for the presence of occipitalization, number/location of congenitally fused segments, and the AADI and PADI.

RESULTS

There were 15 males and 18 females (mean age, 13.9 years). Occipitalization occurred in 48.5% of patients. A fused C2-C3 segment was noted in 72.7% of cases. More motion with respect to AADI was evident on O-C1 and C2-C3 fusion only patients, which were all asymptomatic. Overall, 24.2% of patients were symptomatic. Mean AADI and PADI difference was 2.0 mm (symptomatic: mean, 1.5 mm; asymptomatic: mean, 2.1 mm) and -1.7 mm (symptomatic: mean, -1.0 mm; asymptomatic: mean, -2.0 mm), respectively (P > 0.05).

CONCLUSIONS

Hypermobility of the atlantoaxial junction, as indicated by increased AADI on flexion-extension radiographs, is not necessarily associated with an increased risk for the development of symptoms or neurologic signs in the KFS patient. Occipitalization plays an integral role in the degree of motion at the atlantoaxial region. Greatest AADI values were in patients with occipitalization and a fused C2-C3 segment. The presence of symptoms was not related to the degree of AADI change. Evaluation of the PADI provides additional information for identifying patients at risk for developing symptoms. Nonetheless, KFS patients remain largely asymptomatic.

Incidence of Klumpke's birth palsy: Comparison between two decades

In a previous paper, the incidence of Klumpke's palsy as cited in the English literature over the last decade (1984 to 1994) was found to be 0.6%. However, during the last decade, there have been consistent increases of cesarean section rates. Therefore, it was unknown if this modern obstetric practice affected the incidence of Klumpke's palsy. This review demonstrates that Klumpke's palsy was equally rare (0.7% of birth palsies) in the previous decade (1973 to 1983). It is also shown that 16 out of the 26 cases of Kumpke's palsy reported in the literature over the last two decades were reported from one centre. It is concluded that the incidence of this rare type of birth palsy has not changed with modern obstetric practice and that this palsy is related to vaginal breech deliveries with hyperabduction of the arms.