A case report of spondyloepiphyseal dysplasia congenita

Management of Craniocervical Instability in Spondyloepiphyseal Dysplasia Congenita: Assessment of Literature and Presentation of Two Cases

Spondyloepiphyseal dysplasia congenita (SEDC) is a rare autosomal dominant skeletal dysplasia resulting in impairment of type II collagen function. Phenotypically, this results in various skeletal, ligamentous, ocular, and otologic abnormalities. Platyspondyly, scoliosis, ligamental laxity, and odontoid hypoplasia are common, resulting in myelopathy in a high number of patients due to atlantoaxial instability. Despite patients undergoing surgical fixation, complication rates such as nonunion have been reported to be high. Here within, we present two patients treated with occipitocervical fusion for atlantoaxial instability and early symptoms of progressive myelopathy. We additionally provide a detailed review of the literature to inform practitioners of the spinal manifestations and clinical considerations in SEDC.

Osteoarthritis in a fifty-year-old patient with unfused skeleton due to undiagnosed coexisting cleidocranial and spondyloepiphyseal dysplasia – Case report

Background

Skeletal dysplasia's cause significant neurological symptoms and disrupt the development of many bones and cartilages in the body. Skeletal dysplasia, although a common presentation in paediatric population, rarely presents in older age group.

Case presentation

This case presents a unique incidental finding of skeletal dysplasia in a fifty-year-old male patient who presented with osteoarthritis. Eventual workup uncloaked the presence of cleidocranial dysplasia and spondyloepiphyseal dysplasia. The patient in this case had both dysplasias at the same time.

Discussion

Cleidocranial dysplasia and Spondyloepiphyseal dysplasia are two uncommon autosomal dominant dysplasia's that are often diagnosed in early life and can have serious consequences, including death. It is critical to diagnose a child early in life. Radiology findings from a thorough skeletal examination aid in the early detection of numerous dysplasia's, which helps improving quality of life and allowing for effective treatment.

Conclusion

The novelty of our presented case lies in the rare presentation of CCD and SED occurring concurrently at an older age with accompanying collateral abnormalities usually emerging more commonly in infants. Early diagnosis is thus essential for optimal management.

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Skeletal dysplasia is a heterogeneous group of disorders which are genetic in nature and comprise around 400 disorders.

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In the case presented, radiological findings revealed two very rare skeletal dysplasia in a fifty year old patient which were cleidocranial dysplasia as well spondyloepiphyseal dysplasia.

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This is of particular importance as these are commonly present in neonates and infants but in this case, it was an incidental finding in a patient undergoing radiological investigations for osteoarthritis.

Atlantoaxial dislocation in a patient with nonsyndromic symmetrical dwarfism: Report of a rare case

Congenital anomalies of the craniovertebral junction (CVJ) are complex developmental defects. We describe a patient with atlantoaxial dislocation (AAD) and short stature whose morphopathologydid not fit into any of the previously described syndromic constellations. The patient underwent a reduction of the AAD followed by fixation with C1-C2 transarticular screws. Although numerous syndromes have been linked to both dwarfism and craniovertebral junction anomalies, this patient did not fit into any of these patterns. It is possible that this may be one of the many as yet unrecognized patterns of congenital anomalies.

Os odontoideum syndrome: pathogenesis, clinical patterns and indication for surgical strategies in childhood

Os odontoideum is a rare condition with a controversial pathogenesis and poorly understood natural history. Hypoplasia of the odontoid associated with an independent oval ossicle, with smooth margins widely separated from C2 and well above the superior facets of the axis, is termed "os odontoideum". The neurological manifestations arise from bulbospinal compression both at rest and during motion, due to the craniovertebral junction (CVJ) instability itself. Consequently, the surgical management of os odontoideum should aim at achieving both neural decompression and stabilization of the CVJ. The aims of this paper are to introduce the embryological steps involved in the CVJ development, to underline the updated theories propounded to interpret developmental and congenital disorders of the os odontoideum, to introduce the most updated surgical techniques and to discuss some exemplary cases selected from our personal experience.

A case report of a patient with cleft palate carrying the risk of tetraplegia

Spondyloepiphyseal dysplasia congenita (SEDC) is an inherited disorder of bone growth that results in short-trunk dwarfism, skeletal abnormalities, disorders in vision and hearing, atlanto-axial instability, and cleft palate. This important anomaly of the cervical vertebrae carries the risk of tetraplegia during cleft palate operations. In this case report, we discuss a case of spondyloepiphyseal dysplasia congenita, the perioperative and postoperative measures, and the risk of tetraplegia.

Retrospective study of cervical arthrodesis in patients with various types of skeletal dysplasia

STUDY DESIGN

Retrospective prognostic study.

OBJECTIVE

To evaluate the safety and efficacy of cervical arthrodesis for cervical instability in patients with skeletal dysplasia.

SUMMARY OF BACKGROUND DATA

Individuals with certain skeletal dysplasias have a high incidence of cervical instability, which can lead to compression of the spinal cord and subsequent severe spinal cord symptoms, progressive neurologic decline, quadriplegia, and death.

MATERIALS AND METHODS

The charts of 25 patients with skeletal dysplasia (spondyloepiphyseal dysplasia, spondyloepimetaphyseal dysplasia, pseudoachondroplasia, Morquio, or Kniest) who had undergone cervical arthrodesis to treat instability were reviewed for evidence of fusion, neurologic improvement, and complications.

RESULTS

Of the 25 patients, 23 (92%) achieved a solid bony fusion, and 5 (20%) experienced surgery-related complications. One of the two patients who did not achieve fusion had a stable pseudarthrosis without neurologic complications, and additional surgical intervention was unnecessary; the second patient is contemplating revision surgery. Of 16 patients with preoperative neurologic manifestations, 14 (88%) experienced improvement.

CONCLUSION

Cervical arthrodesis can be a safe and effective treatment for patients with skeletal dysplasia and cervical instability, despite the inherent complications associated with a dysplastic skeleton. The procedure can preserve and/or improve neurologic function while minimizing the risk of neurologic injury from spinal cord compression.