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Chehrassan M, Shakeri M, Nikouei F, Jafari B, Mahabadi EA, Ghandhari H. Surgical treatment of scoliosis in patients with osteogenesis imperfecta: a single institution case series. Musculoskelet Surg 2024:10.1007/s12306-024-00842-0. [PMID: 38907836 DOI: 10.1007/s12306-024-00842-0] [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: 12/15/2023] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable. METHODS This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery. RESULTS Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers. CONCLUSION Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.
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Affiliation(s)
- M Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - M Shakeri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - F Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - B Jafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - E A Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - H Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Hald JD, Langdahl B, Folkestad L, Wekre LL, Johnson R, Nagamani SCS, Raggio C, Ralston SH, Semler O, Tosi L, Orwoll E. Osteogenesis Imperfecta: Skeletal and Non-skeletal Challenges in Adulthood. Calcif Tissue Int 2024:10.1007/s00223-024-01236-x. [PMID: 38836890 DOI: 10.1007/s00223-024-01236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
Osteogenesis imperfecta (OI) is a Mendelian connective tissue disorder associated with increased bone fragility and other clinical manifestations most commonly due to abnormalities in production, structure, or post-translational modification of type I collagen. Until recently, most research in OI has focused on the pediatric population and much less attention has been directed at the effects of OI in the adult population. This is a narrative review of the literature focusing on the skeletal as well as non-skeletal manifestations in adults with OI that may affect the aging individual. We found evidence to suggest that OI is a systemic disease which involves not only the skeleton, but also the cardiopulmonary and gastrointestinal system, soft tissues, tendons, muscle, and joints, hearing, eyesight, dental health, and women's health in OI and potentially adds negative affect to health-related quality of life. We aim to guide clinicians as well as draw attention to obvious knowledge gaps and the need for further research in adult OI.
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Affiliation(s)
- Jannie Dahl Hald
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Centre for Rare Diseases, Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Folkestad
- Bone and Mineral Unit, Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Riley Johnson
- Bone and Mineral Research Unit, Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Children's Hospital, Houston, TX, 77030, USA
| | - Cathleen Raggio
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Edinburgh, EH 2XU, UK
| | - Oliver Semler
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Laura Tosi
- Division of Orthopaedics & Sports Medicine, Children's National Hospital, Washington, DC, 20010, USA
| | - Eric Orwoll
- Bone and Mineral Research Unit, Department of Medicine, Oregon Health & Science University, Portland, USA
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El-Tecle N, Dahdaleh NS, Cloney MB, Shlobin NA, Koski TR, Wolinsky JP. Advances, Challenges, and Future Directions in the Management of Craniovertebral Junction Pathologies. World Neurosurg 2023; 175:183-189. [PMID: 36990348 DOI: 10.1016/j.wneu.2023.03.098] [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: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
In this third article in a 3-article series on the craniocervical junction, we define the terms "basilar impression," "cranial settling," "basilar invagination," and "platybasia," noting that these terms are often used interchangeably but represent distinct entities. We then provide examples that represent these pathologies and treatment paradigms. Finally, we discuss the challenges and future direction in the craniovertebral junction surgery space.
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Affiliation(s)
- Najib El-Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Michael B Cloney
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jean Paul Wolinsky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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De Nova-García MJ, Sola RG, Burgueño-Torres L. Influence of the Severity of Osteogenesis Imperfecta on Cranial Measurements. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1029. [PMID: 37371261 DOI: 10.3390/children10061029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Osteogenesis Imperfecta (OI) is a disease that causes bone fragility and deformities, affecting both the cranial base and the craniocervical junction, and may lead to other neurological disorders. A retrospective cross-sectional study was carried out based on cephalometric analysis of the cranial base in a sample of patients with OI, in lateral skull radiographs and magnetic resonance imaging (MRI), comparing them with a sample of age-matched controls. When the different variables of the craniocervical junction were analyzed, significance was found in comparisons with the different age groups. All measurements of the variables studied stabilized as growth progressed. For most of the variables, the severity of the disease influences the measurements of the skull base, with statistically significant differences. Both age and severity of the disease are factors that directly influence the anatomy of the craniocervical junction in these patients and may serve as indicators in the early detection and prevention of other derived alterations.
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Affiliation(s)
| | - Rafael G Sola
- UAM Chair "Innovation in Neurosurgery", Department of Surgery, Autonomous University of Madrid, 28049 Madrid, Spain
| | - Laura Burgueño-Torres
- Dental Clinical Specialties Department, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain
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Ludwig K, Seiltgens C, Ibba A, Saran N, Ouellet JA, Glorieux F, Rauch F. Craniocervical abnormalities in osteogenesis imperfecta type V. Osteoporos Int 2022; 33:177-183. [PMID: 34350492 DOI: 10.1007/s00198-021-06088-x] [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: 04/23/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED Craniocervical abnormalities in osteogenesis imperfecta (OI) such as basilar invagination or cervical kyphosis can cause severe neurological morbidity. These abnormalities may be more frequent in OI type V compared with other OI subtypes of similar disease severity, underlining the importance of screening in this group. INTRODUCTION Craniocervical abnormalities in osteogenesis imperfecta (OI) can cause severe neurological morbidity. Although radiological cranial base abnormalities in OI have been well described in the literature, there are limited data on these abnormalities in OI type V and their association with clinical sequelae. METHODS A retrospective case series on patients with craniocervical abnormalities in OI type V at our institution. RESULTS Craniocervical abnormalities were present in 7 of 37 patients with OI type V (19%). For 5 patients (age at last follow-up: 5 to 26 years; 2 females), sufficient information was available for inclusion in the case series. All had genetically confirmed OI type V. Age range at diagnosis of the craniocervical abnormality was 1 day to 18 years. Basilar invagination was present in 3 patients; 2 had cervical kyphosis. Dysplasia of upper cervical vertebrae or base of skull was seen in 3 patients. The severity of the craniocervical abnormality did not clearly correlate with the severity of the OI phenotype. Three patients required surgical intervention (ages 7, 11, and 26 years) due to compression of the spinal cord or brainstem. Craniocervical abnormalities were detected incidentally or on screening in 3 patients, and only 2 had significant positive findings on neurological examination. CONCLUSION A variety of craniocervical abnormalities are seen in OI type V including dysplasia of the cervical vertebrae. These cases highlight the importance of screening patients with OI type V with lateral skull and cervical spine x-rays throughout childhood and after skeletal maturity.
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Affiliation(s)
- K Ludwig
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - C Seiltgens
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - A Ibba
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - N Saran
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - J A Ouellet
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - F Glorieux
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - F Rauch
- Shriners Hospitals for Children, 1003 Boulevard Decarie, Montreal, QC, H4A 0A9, Canada.
- Department of Pediatrics, McGill University, Montreal, QC, Canada.
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Jannelli G, Moiraghi A, Paun L, Tessitore E, Dayer R, Bartoli A. Severe Basilar impression in osteogenesis imperfecta treated with halo gravity traction, occipitocervicothoracic fusion, foramen magnum and upper cervical decompression and expansive duroplasty: a technical note. Childs Nerv Syst 2022; 38:991-995. [PMID: 35296931 PMCID: PMC9038892 DOI: 10.1007/s00381-022-05495-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare bone disease due to an abnormal synthesis of 1-type collagen. OI is frequently associated with basilar impression (BI), defined by the elevation of the clivus and floor of the posterior fossa with subsequent migration of the upper cervical spine and the odontoid peg into the base of the skull. Bone intrinsic fragility leading to fractures and deformity, brainstem compression and impaired CSF circulation at cranio-vertebral junction (CVJ) makes the management of these conditions particularly challenging. Different surgical strategies, including posterior fossa decompression with or without instrumentation, transoral or endonasal decompression with posterior occipito-cervical fusion, or halo gravity traction with posterior instrumentation have been reported, but evidence about best modalities treatment is still debated. In this technical note, we present a case of a 16-years-old patient, diagnosed with OI and BI, treated with halo traction, occipito-cervico-thoracic fixation, foramen magnum and upper cervical decompression, and expansive duroplasty. We focus on technical aspects, preoperative work up and postoperative follow up. We also discuss advantages and limitations of this strategy compared to other surgical techniques.
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Affiliation(s)
- Gianpaolo Jannelli
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France ,Université de Paris, Sorbonne Paris Cité, Paris, France ,IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Inserm, U1266 Paris, France
| | - Luca Paun
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Enrico Tessitore
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Departments of Pediatric Orthopedics, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Bartoli
- Department of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Wadanamby S, El Garwany S, Connolly D, Arundel P, Bishop NJ, DeVile CJ, Calder AD, Crowe B, Burren CP, Saraff V, Offiah AC. Monitoring Skull Base Abnormalities in Children with Osteogenesis Imperfecta - Review of Current Practice and a Suggested Clinical Pathway. Bone 2022; 154:116235. [PMID: 34688943 DOI: 10.1016/j.bone.2021.116235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the context of a lack of national consensus on the benefits of skull base imaging in children with osteogenesis imperfecta (OI), this study aims to analyse and correlate the clinical symptoms and radiological images of children with severe OI. METHODS A retrospective case notes and image analysis was carried out on children with complex OI between 2012 and 2018 at a specialist tertiary centre. Data were collected on patient demographic factors, clinical data, imaging findings (presence of Wormian bones, platybasia, basilar impression (McGregor's technique) and basilar invagination (McRae's technique)), and clinical features at the time of imaging. RESULTS Of the 127 patients in the OI database, 94 were included. A total of 321 radiographs, 21 CT scans and 39 MRI scans were analysed. Average frequency of radiographs was 8 per 10 years. Of the 94 patients, 58 (62%), 10 (11%), 1 (1%) demonstrated platybasia, basilar impression, and basilar invagination, respectively. Of the radiographs analysed, platybasia, basilar impression, basilar invagination, and the presence of Wormian bones, could not be evaluated in 71 (22.3%), 48 (15.2%), 61 (19.5%) and 28 (9.4%) radiographs respectively (due to poor positioning, anatomical abnormalities, and poor image quality). Of the 140 radiographs with platybasia, 17 (12%) also demonstrated basilar impression compared to only 3 (2.9%) out of the 99 without platybasia (p = 0.03). No significant associations were seen between the presence of Wormian bones and basilar impression. Of the 39 MRIs, additional information on CSF flow rate, spinal cord signal and cerebellar morphology was reported in 14 (36%). There was a lack of concordance between MRI and matched radiographs in 7.1% (1/14) and 36% (5/14) for platybasia and basilar impression respectively, with full concordance for basilar invagination. Fewer than 5% had positive clinical symptoms/signs at the time of imaging; 2% (7/321) had macrocephaly, 0.6% (2/321) headache, all other neurological features were absent). Clinical features were not documented in >85% of patients. CONCLUSION The apparent low prevalence of clinical symptoms and signs and of radiologically identified cranio-cervical abnormalities, suggests that current levels of serial imaging may be excessive. Until larger prospective studies clarify these issues, we suggest a clinical pathway for base of skull imaging which proposes a risk stratification approach to radiographic frequency and suggests parameters for proceeding to MRI.
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Affiliation(s)
- S Wadanamby
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK.
| | - S El Garwany
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Suez Canal University, Faculty of Medicine, Department of Radiology, 4.5 Km Ring Road, Ismailia, Egypt
| | - Dja Connolly
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - P Arundel
- Department of Paediatrics, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - N J Bishop
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Department of Paediatrics, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - C J DeVile
- The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - A D Calder
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - B Crowe
- The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - C P Burren
- Department of Paediatric Endocrinology and Diabetes, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin St, Bristol BS2 8BJ, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - V Saraff
- Department of Paediatric Endocrinology, Birmingham Women's and Children's Hospital, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
| | - A C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH, UK; Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK; Highly Specialised Service for Severe, Complex and Atypical Osteogenesis Imperfecta (NHS England) - Birmingham Women's and Children's Hospital, UK; Bristol Royal Hospital for Children, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, UK; Sheffield Children's Hospital NHS Foundation Trust, UK
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Abstract
BACKGROUND Osteogenesis imperfecta (OI) can develop a protrusio acetabuli deformity. However, the authors observed a pseudo-protrusio-type acetabular deformity (PPAD) on 3-dimensional computed tomography (3D-CT). Hence, we systematically reviewed 3D-CT and pelvis radiographs of OI patients and report the incidence and patterns of acetabular deformity in OI patients and the associated radiographic signs. METHODS The study included 590 hips of 295 OI patients, who were older than 5 years, and did not have a pelvic fracture. The incidence of a deformed acetabulum (center-edge angle >40 degrees) and its correlation with disease severity were investigated. In 40 hips for which 3D-CT was available, 3-dimensional morphology of the acetabular deformity was analyzed to delineate PPAD. On plain radiographs, PPAD-related signs were determined, focusing on the contour of ilioischial line, iliopectineal line, acetabular line, and their relationship. These radiographic signs were also evaluated in the remaining hips with deformed acetabula that did not have 3D-CT. RESULTS One hundred twenty-three hips of 590 hips (21%) showed deformed acetabula. The incidence of deformed acetabula was significantly associated with disease severity (P<0.001). Three-dimensional analysis showed that 10 hips had protrusio acetabuli, whereas 17 had PPAD, which showed that the hemipelvis was crumpled, the acetabular roof was rotated upwardly and medially, and the hip center migrated superiorly, uncovering the anterior femoral head. Among the PPAD-related signs, superomedial bulging of the iliopectineal line was the most predictive radiographic sign (73% sensitivity and 100% specificity). This sign was also observed in almost one third of deformed acetabula of those investigated only with plain radiographs. CONCLUSIONS This study showed that acetabular deformity is common in OI patients and is associated with disease severity. A substantial number of hips showed PPAD, which may not cause femoroacetabular impingement but result in anterior uncovering of the hip joint. Superomedial bulging of the iliopectineal line suggests this pattern of acetabular deformity. LEVEL OF EVIDENCE Lever IV-prognostic studies.
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Cho TJ, Ko JM, Kim H, Shin HI, Yoo WJ, Shin CH. Management of Osteogenesis Imperfecta: A Multidisciplinary Comprehensive Approach. Clin Orthop Surg 2020; 12:417-429. [PMID: 33274017 PMCID: PMC7683189 DOI: 10.4055/cios20060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by recurring fractures and limb and spine deformities. With the advent of medical therapeutics and the discovery of causative genes, as well as the introduction of a newly devised intramedullary rod, the general condition and ambulatory function of patients diagnosed with OI have been improved over the past decades. This review covers recent developments in research and management of OI.
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Affiliation(s)
- Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoungmin Kim
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Joon Yoo
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Henderson FC, Francomano CA, Koby M, Tuchman K, Adcock J, Patel S. Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization. Neurosurg Rev 2019; 42:915-936. [PMID: 30627832 PMCID: PMC6821667 DOI: 10.1007/s10143-018-01070-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
A great deal of literature has drawn attention to the "complex Chiari," wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0-10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p < 0.001, vertigo (92%), imbalance (82%), dysarthria (80%), dizziness (70%), memory problems (69%), walking problems (69%), function (KPS) (p < 0.001). Neurological deficits improved in all subjects. The CXA average improved from 127° to 148° (p < 0.001). The Grabb-Oakes and Harris measurements returned to normal. Fusion occurred in 100%. There were no significant differences between the 2- and 5-year period. Two patients returned to surgery for a superficial wound infections, and two required transfusion. All patients who had rib harvests had pain related that procedure (3/10), which abated by 5 years. The results support the literature, that open reduction of the kyphotic CXA to lessen ventral brainstem deformity, and fusion/stabilization to restore stability in patients with HCTD is feasible, associated with a low surgical morbidity, and results in enduring improvement in pain and function. Rib harvest resulted in pain for several years in almost all subjects.
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Affiliation(s)
- Fraser C Henderson
- Doctor's Community Hospital, Lanham, MD, USA.
- The Metropolitan Neurosurgery Group, LLC, Silver Spring, MD, USA.
| | | | - M Koby
- Doctor's Community Hospital, Lanham, MD, USA
| | - K Tuchman
- The Metropolitan Neurosurgery Group, LLC, Silver Spring, MD, USA
| | - J Adcock
- Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - S Patel
- Medical University of South Carolina, Charleston, SC, USA
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11
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Reznikov N, Dagdeviren D, Tamimi F, Glorieux F, Rauch F, Retrouvey J. Cone-Beam Computed Tomography of Osteogenesis Imperfecta Types III and IV: Three-Dimensional Evaluation of Craniofacial Features and Upper Airways. JBMR Plus 2019; 3:e10124. [PMID: 31346560 PMCID: PMC6636768 DOI: 10.1002/jbm4.10124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
This cross-sectional study investigated the natural history of craniofacial deformities in osteogenesis imperfecta (OI) and determined the impact of three-dimensional (3D) analysis on diagnosis and treatment planning in orthodontics and orthognathic surgery in comparison to conventional two-dimensional (2D) cephalometric examination. 3D images of the craniofacial complex were acquired during 1 calendar year using cone-beam computed tomography (CBCT) from a cohort of 41 individuals (aged 11 to 35 years; 28 females) with OI type III (n = 13) or IV (n = 28). 3D evaluation of the craniocervical junction and upper airways was conducted using InVivoTM. 2D lateral cephalogram was constructed, traced, and examined using the University of Western Ontario analysis (DolphinTM). Quantitative and qualitative parameters were compared between OI type III and type IV groups (unpaired t test) and the unaffected population (Z-score). 3D evaluation revealed a high prevalence of craniocervical abnormalities, craniofacial asymmetries, and nasal septum deviation in both OI groups. Mean airway dimensions were comparable to the non-affected population norms, except for 5 individuals who had insufficient airway dimensions. In 2D, the maxilla was retrognathic and hypoplastic, and the mandibular position was convergent with respect to the face, resulting in mandibular prognathism and face height reduction. The 2D trends were more pronounced in OI type III, whereas the 3D craniocervical and airway abnormalities were common in both types. This study illustrates the prevalence of craniofacial and airway anomalies in OI that occur along with facial deformities are not associated with postcranial phenotype and OI type, are apparent only in 3D evaluation, and are likely to influence treatment strategy. For OI patients, a team effort involving a dentist, orthodontist, neurologist, and ear-nose-throat (ENT) practitioner is recommended for successful management of craniofacial deformities.
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Affiliation(s)
| | | | - Faleh Tamimi
- Faculty of DentistryMcGill UniversityMontrealCanada
| | | | - Frank Rauch
- Shriners Hospitals for Children–CanadaMontrealCanada
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12
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Tauer JT, Robinson ME, Rauch F. Osteogenesis Imperfecta: New Perspectives From Clinical and Translational Research. JBMR Plus 2019; 3:e10174. [PMID: 31485550 PMCID: PMC6715783 DOI: 10.1002/jbm4.10174] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 12/30/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a monogenic bone fragility disorder that usually is caused by mutations in one of the two genes coding for collagen type I alpha chains, COL1A1 or COL1A2. Mutations in at least 18 other genes can also lead to an OI phenotype. As genetic testing is more widely used, mutations in these genes are also more frequently discovered in individuals who have a propensity for fractures, but who do not have other typical clinical characteristics of OI. Intravenous bisphosphonate therapy is still the most widely used drug treatment approach. Preclinical studies in OI mouse models have shown encouraging effects when the antiresorptive effect of a bisphosphonate was combined with bone anabolic therapy using a sclerostin antibody. Other novel experimental treatment approaches include inhibition of transforming growth factor beta signaling with a neutralizing antibody and the inhibition of myostatin and activin A by a soluble activin receptor 2B. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
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Affiliation(s)
| | | | - Frank Rauch
- Shriners Hospital for Children Montreal Quebec Canada
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13
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Castelein RM, Hasler C, Helenius I, Ovadia D, Yazici M. Complex spine deformities in young patients with severe osteogenesis imperfecta: current concepts review. J Child Orthop 2019; 13:22-32. [PMID: 30838072 PMCID: PMC6376432 DOI: 10.1302/1863-2548.13.180185] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The severity of osteogenesis imperfecta (OI), the associated reduced quality and quantity of collagen type I, the degree of bone fragility, ligamentous laxity, vertebral fractures and multilevel vertebral deformities all impair the mechanical integrity of the whole spinal architecture and relate to the high prevalence of progressive kyphoscoliotic deformities during growth. Bisphosphonate therapy may at best slow down curve progression but does not seem to lower the prevalence of deformities or the incidence of surgery. Brace treatment is problematic due to pre-existing chest wall deformities, stiffness of the curve and the brittleness of the ribs which limit transfer of corrective forces from the brace shell to the spine. Progressive curves entail loss of balance, chest deformities, pain and compromise of pulmonary function and eventually require surgical stabilization, usually around puberty. Severe vertebral deformities including deformed, small pedicles, highly brittle bones and chest deformities, short deformed trunks and associated issues like C-spine and cranial base abnormalities (basilar impressions, cervical kyphosis) as well as deformed lower and upper extremities are posing multiple peri- and intraoperative challenges. Hence, an early multidisciplinary approach (anaesthetist, pulmonologist, paediatric orthopaedic spine surgeon) is mandatory. This paper was written under the guidance of the Spine Study Group of the European Paediatric Orthopaedic Society. It highlights the most pertinent information given in the current literature and various practical aspects on surgical care of spine deformities in young OI patients based on the personal experience of the contributing authors.
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Affiliation(s)
- R. M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, The Netherlands
| | - C. Hasler
- Orthopaedic Department, Children’s Hospital, University of Basel, Switzerland, Correspondence should be sent to C. Hasler, Orthopaedic Department, Children’s Hospital, University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland. E-mail:
| | - I. Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - D. Ovadia
- Department of Paediatric Orthopaedic Surgery, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affilated to Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - M. Yazici
- Hacettepe University, Faculty of Medicine, Dept of Orthopaedics Ankara, Turkey
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14
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Takeyari S, Kubota T, Miyata K, Yamamoto K, Nakayama H, Yamamoto K, Ohata Y, Kitaoka T, Yanagi K, Kaname T, Ozono K. Japanese patient with Cole-carpenter syndrome with compound heterozygous variants of SEC24D. Am J Med Genet A 2018; 176:2882-2886. [PMID: 30462379 DOI: 10.1002/ajmg.a.40643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/20/2023]
Abstract
Cole-Carpenter syndrome is a rare skeletal dysplasia associated with low-bone mass or an osteogenesis imperfecta (OI)-like syndrome. Only 3 and 6 variants in SEC24D have been reported in patients with Cole-Carpenter syndrome type 2 and autosomal recessive OI, respectively. We describe a 15-year-old Japanese boy with short stature of the short-trunk type and craniofacial abnormalities including ocular proptosis, marked frontal bossing, midface hypoplasia, and micrognathia. These features were consistent with a diagnosis of Cole-Carpenter syndrome. He had low-bone mineral density and basilar impression. Whole exome sequencing analysis identified biallelic variants in SEC24D (p.Arg484* and p.Arg313His) in the patient. We will report a patient with compound heterozygous variants of SEC24D causing Cole-Carpenter syndrome type 2.
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Affiliation(s)
- Shinji Takeyari
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Miyata
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Yamamoto
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirofumi Nakayama
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,The Japan Environment and Children's Study, Osaka Unit Center, Osaka, Japan
| | - Keiko Yamamoto
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhisa Ohata
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,The 1st. Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kumiko Yanagi
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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15
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Iwai Y, Ishibashi K, Yamanaka K. Gamma Knife Radiosurgery for Trigeminal Neuralgia Associated with Osteogenesis Imperfecta. World Neurosurg 2018; 115:24-28. [DOI: 10.1016/j.wneu.2018.03.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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16
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Piantoni L, Noel MA, Francheri Wilson IA, Tello CA, Galaretto E, Remondino RG, Bersusky ES. Surgical Treatment With Pedicle Screws of Scoliosis Associated With Osteogenesis Imperfecta in Children. Spine Deform 2017; 5:360-365. [PMID: 28882354 DOI: 10.1016/j.jspd.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To assess results of posterior instrumented fusion using pedicle screws in 12 children with osteogenesis imperfecta (OI) with spinal deformity at a single institution from 2001 to 2012. SUMMARY OF BACKGROUND DATA This is the first case series of OI patients who underwent non-cement augmented screw-rod instrumented fusion published in the literature. METHODS Of a total of 54 children with spinal deformity associated with OI, 12 (22.2%) were submitted to posterior spinal fusion with pedicle screws (80% density) because of severe spinal deformity. Here we reported the results in seven females and five males. RESULTS Five thoracic (41.7%), five double (thoracic and lumbar 41.7%), and two lumbar (16.7%) curves were considered. The mean number of fused levels was 11.8 (range: 5 to 16). Mean age at surgery was 13 years 8 months. Mean follow-up was 7 years 11 months (range: 3 years 7 months to 16 years 1 month). The mean preoperative scoliosis angle was 75.6°, whereas the postoperative angle was 31.4° (58.5% correction rate). The mean preoperative kyphosis angle was 57.4° and the postoperative angle was 42.3°. We observed one superficial infection, one dural tear, and three cases of proximal junctional kyphosis; two patients required one revision surgery each (2 years and 4 months postoperatively on average). CONCLUSIONS To our knowledge, this is the first case series published in the literature regarding OI with instrumented fusion with non-cement augmented pedicle screws exclusively in children with spinal deformity. We found that posterior spinal fusion with the screw-rod system in OI deformity in children is feasible and reliable, and has acceptable clinical and imaging results in the long-term follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lucas Piantoni
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina.
| | - Mariano A Noel
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Ida A Francheri Wilson
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Carlos A Tello
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Rodrigo G Remondino
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Ernesto S Bersusky
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
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17
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Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review. Neurosurg Rev 2017; 41:149-163. [PMID: 28258417 PMCID: PMC5748419 DOI: 10.1007/s10143-017-0830-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 01/19/2023]
Abstract
There is growing recognition of the kyphotic clivo-axial angle (CXA) as an index of risk of brainstem deformity and craniocervical instability. This review of literature and prospective pilot study is the first to address the potential correlation between correction of the pathological CXA and postoperative clinical outcome. The CXA is a useful sentinel to alert the radiologist and surgeon to the possibility of brainstem deformity or instability. Ten adult subjects with ventral brainstem compression, radiographically manifest as a kyphotic CXA, underwent correction of deformity (normalization of the CXA) prior to fusion and occipito-cervical stabilization. The subjects were assessed preoperatively and at one, three, six, and twelve months after surgery, using established clinical metrics: the visual analog pain scale (VAS), American Spinal InjuryAssociation Impairment Scale (ASIA), Oswestry Neck Disability Index, SF 36, and Karnofsky Index. Parametric and non-parametric statistical tests were performed to correlate clinical outcome with CXA. No major complications were observed. Two patients showed pedicle screws adjacent to but not deforming the vertebral artery on post-operative CT scan. All clinical metrics showed statistically significant improvement. Mean CXA was normalized from 135.8° to 163.7°. Correction of abnormal CXA correlated with statistically significant clinical improvement in this cohort of patients. The study supports the thesis that the CXA maybe an important metric for predicting the risk of brainstem and upper spinal cord deformation. Further study is feasible and warranted.
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18
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Abstract
Osteogenesis imperfecta is a genetic disorder of type I collagen. Although multiple genotypes and phenotypes are associated with osteogenesis imperfecta, approximately 90% of the mutations are in the COL1A1 and COL1A2 genes. Osteogenesis imperfecta is characterized by bone fragility. Patients typically have multiple fractures or limb deformity; however, the spine can also be affected. Spinal manifestations include scoliosis, kyphosis, craniocervical junction abnormalities, and lumbosacral pathology. The incidence of lumbosacral spondylolysis and spondylolisthesis is higher in patients with osteogenesis imperfecta than in the general population. Use of diphosphonates has been found to decrease the rate of progression of scoliosis in patients with osteogenesis imperfecta. A lateral cervical radiograph is recommended in patients with this condition before age 6 years for surveillance of craniocervical junction abnormalities, such as basilar impression. Intraoperative and anesthetic considerations in patients with osteogenesis imperfecta include challenges related to fracture risk, airway management, pulmonary function, and blood loss.
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19
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20
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Abstract
Osteogenesis imperfecta (OI) is a rare disorder of type 1 collagen with 13 currently identified types attributable to inherited abnormalities in type 1 collagen amount, structure, or processing. The disease is characterized by an increased susceptibility to bony fracture. In addition to the skeletal phenotype, common additional extraskeletal manifestations include blue sclerae, dentinogenesis imperfecta, vascular fragility, and hearing loss. Medical management is focused on minimizing the morbidity of fractures, pain, and bone deformities by maximizing bone health. Along with optimizing Vitamin D status and calcium intake and physical/occupational therapy, individualized surgical treatment may be indicated. Pharmacological therapy with bisphosphonate medications is now routinely utilized for moderate to severe forms and appears to have a good safety profile and bone health benefits. New therapies with other anti-resorptives as well as anabolic agents and transforming growth factor (TGF)β antibodies are in development. Other potential treatment modalities could include gene therapy or mesenchymal cell transplant. In the future, treatment choices will be further individualized in order to reduce disease morbidity and mortality.
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Affiliation(s)
- Inas H Thomas
- Section of Pediatric Endocrinology, School of Medicine, University of Michigan, 1500 E. Medical Center Dr., D1205 MPB, SPC 5718, Ann Arbor, MI, 48109, USA.
| | - Linda A DiMeglio
- Section of Pediatric Endocrinology/Diabetology, School of Medicine, Indiana University, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202-5225, USA.
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21
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The selective odontoidectomy: endoscopic endonasal approach to the craniocervical junction. J Craniofac Surg 2015; 25:1482-7. [PMID: 24943506 DOI: 10.1097/scs.0000000000000788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The resection of the odontoid process via an extended endoscopic endonasal approach has been recently proposed as an alternative to the microscopic transoral method. We aimed to delineate a minimally invasive endoscopic transnasal odontoidectomy and to describe the endoscopic anatomy of the anterior craniovertebral junction (CVJ). MATERIALS AND METHODS The anterior CVJ of 14 fresh adult cadavers were selectively accessed via a binostril endoscopic endonasal approach using 0- and 30-degree endoscopes. RESULTS The nasopharynx was widely exposed without removing any of the turbinates and without performing a sphenoidotomy. Occipital condyles and lateral masses of the C1 vertebra have been exposed inferiorly at lateral margins of the exposure, in addition to the foramen lacerum, which came into view at the superolateral corner of the operative field. The anterior arch of C1 and the upper 1.5 cm of the odontoid process of C2 have been removed via a minimally invasive endoscopic transnasal approach in all dissections. CONCLUSIONS We propose the selective odontoidectomy as a minimally invasive method for the endoscopic endonasal removal of the odontoid process. By using this approach, turbinates and the sphenoid sinus remain unharmed. In addition, this approach may be used in exposing pathologies situated laterally at the anterior CVJ, such as the lateral masses of atlas and occipital condyles.
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22
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Abstract
Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. For patients affected by these processes, radiologic imaging plays a central role in diagnosis, monitoring treatment, and risk stratification. Radiologists should be familiar with the diseases, intimately aware of the imaging findings, and possessive of multimodality expertise to wisely guide the best practice of medicine. The purpose of this paper is to review the imaging features and characteristics of the most common types of metabolic bone disease with highlights of clinically relevant information so that readers can better generate appropriate differential diagnoses and recommendations. For this review, a thorough literature search for the most up-to-date information was performed on several key types of metabolic bone disease: osteoporosis, osteomalacia, rickets, scurvy, renal osteodystrophy, hyperparathyroidism, Paget’s disease, osteogenesis imperfecta, acromegaly, and osteopetrosis. Although they all affect the bone, these diseases have both shared characteristic features that can be discerned through imaging.
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23
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Ríos-Rodenas M, de Nova J, Gutiérrez-Díez MP, Feijóo G, Mourelle MR, Garcilazo M, Ortega-Aranegui R. A cephalometric method to diagnosis the craniovertebral junction abnormalities in osteogenesis imperfecta patients. J Clin Exp Dent 2015; 7:e153-8. [PMID: 25810828 PMCID: PMC4368004 DOI: 10.4317/jced.52126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/12/2014] [Indexed: 01/29/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. Their typical oral and craneofacial characteristics (Dentinogenesis imperfecta type I and class III malocclusion), involve the dentist in the multidisciplinary team that treat these patients. It is usual to perform lateral skull radiographs for the orthodontic diagnosis. In addition, this radiograph is useful to analyse the junctional area between skull base and spine, that could be damaged in OI. Pathology in the craneovertebral junction (CVJ) is a serious complication of OI with a prevalence ranging from rare to 37%. To diagnosis early skull base anomalies in these patients, previously the neurological symptoms have been appear, we make a simple cephalometric analysis of the CVJ. This method has four measurements and one angle. Once we calculate the values of the OI patient, we compare the result with the mean and the standard deviations of an age-appropriate average in healthy controls. If the patient has a result more than 2,5 SDs above the age-appropriate average in healthy controls, we should to refer the patient to his/her pediatrician or neurologist. These doctors have to consider acquiring another diagnostic images to be used to determine cranial base measurements with more reliability. Thereby, dentists who treat these patients, must be aware of the normal radiological anatomy of the cervical spine on the lateral cephalogram. Key words:Osteogenesis imperfecta, craniovertebral junction, cephalometric.
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Affiliation(s)
- Mercedes Ríos-Rodenas
- Profesora asociada de Odontopediatría (Universidad Alfonso X El Sabio). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Joaquín de Nova
- Profesor Titular de Odontopediatría (Universidad Complutense de Madrid (UCM)). Responsable Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - María-Pilar Gutiérrez-Díez
- Especialista en Endocrinología Pediátrica. Unidad de Osteogénesis Imperfecta (Hospital Universitario de Getafe (Madrid)). Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Gonzalo Feijóo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Maria-Rosa Mourelle
- Profesora Contratada Doctora de la UCM. Investigadora Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Mario Garcilazo
- Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
| | - Ricardo Ortega-Aranegui
- Profesor asociado (UCM). Investigador Proyecto. Proyecto (FMM2013AP123942013) Fundación Mutua Madrileña (X Convocatoria)
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Pakkasjärvi N, Mattila M, Remes V, Helenius I. Upper cervical spine fusion in children with skeletal dysplasia. Scand J Surg 2015; 102:189-96. [PMID: 23963034 DOI: 10.1177/1457496913486742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Skeletal dysplasias have been associated with upper cervical instability. Many patients are initially asymptomatic, but the instability may progress to subluxation and dislocation and complications thereof, including death. Surgery is hampered by petite osseous structures and low bone formation rate. AIM To review the outcomes of surgical fusion of upper cervical instability in children with rare skeletal dysplasias. MATERIAL AND METHODS A retrospective study of eight children with five different rare skeletal dysplasias needing upper cervical instrumented stabilization. Cases were evaluated for clinical, radiologic, and quality-of-life outcomes, with median follow-up time of 5 years. RESULTS Six patients underwent posterior, segmental cervical spine instrumentation and fusion (three C1/C2 fusions, three occipitocervical fusions), one anterior cervical instrumented spinal fusion, and one anteroposterior fusion. Autogenous bone grafting was used in all patients, and seven were immobilized using a halo body jacket. Nonunion in occipitocervical fusions was common in these patients (3/8 patients). Rib autograft from occiput to cervical spine with recombinant human BMP-2 was used to salvage nonunions. CONCLUSIONS Surgical fixation in the pediatric cervical spine is hampered by fragile posterior structures. A postoperative immobilization by halo vest for 4 months is customary. Selective anterior corpectomy and plate fixation is not recommended in pediatric patients with skeletal dysplasias. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- N Pakkasjärvi
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Ma H, Lv G, Wang B, Kuang L, Wang X. Endoscopic transcervical anterior release and posterior fixation in the treatment of irreducible vertical atlantoaxial dislocation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1749-54. [PMID: 24831127 DOI: 10.1007/s00586-014-3352-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/28/2022]
Abstract
Vertical atlantoaxial dislocation is a type of atlantoaxial instability with upper cervical spinal cord compression. The transoral ondontoid resection with posterior fixation is the gold standard for ventral decompression. Results are satisfying though surgery can be challenging due to its invasiveness. The endoscopic transcervical anterior release could provide sufficient ventral decompression with less collateral damage. In the illustrative case, anatomic reduction was achieved with significant improvement in neurological function and radiographic parameters. Endoscopic transcervical anterior release and posterior fixation appears to be a viable and interesting alternative for the treatment of vertical atlantoaxial dislocation in properly selected individuals, and its implementation could significantly reduce the post-surgical complications.
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Affiliation(s)
- Hong Ma
- Department of Spinal Surgery, Second Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China,
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Abstract
Craniovertebral dislocation is uncommon, but its diagnosis is important taking into account the potential severity of the neurologic complications. A number of causes are known; the most common are Down syndrome, rheumatoid arthritis, Paget's disease, other metabolic bone diseases, and craniocervical trauma. Down's syndrome is a relatively common clinical condition but craniovertebral subluxation is only observed in a small percentage of patients. About half of all cervical spine injuries affect the atlanto-occipital region and C2 vertebra. In rheumatoid arthritis, craniocervical dislocation occurs in up to 40% of patients with severe disease. In Paget's disease, involvement of the craniovertebral region occurs in about 30% of all cases. The clinical neurologic syndrome is characterized by local pain, features of upper spinal cord and medullary compression, positive Lhermitte phenomenon, syncope associated with neck flexion, vertebral artery obstruction or dissection leading to stroke, and asymmetrical lower cranial nerve palsies. Neuroimaging is essential to confirm the clinical diagnosis and to categorize severity. The treatment of this disorder is usually surgical, but traction and external immobilization is relevant in some cases. Specific conditions may require additional treatments such as radiotherapy, antibiotics, or chemotherapy.
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Debette S, Germain DP. Neurologic manifestations of inherited disorders of connective tissue. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:565-76. [PMID: 24365320 DOI: 10.1016/b978-0-7020-4086-3.00037-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inherited disorders of connective tissue are single gene disorders affecting structure or function of the connective tissue. Neurological manifestations are classic and potentially severe complications of many such disorders. The most common neurological manifestations are cerebrovascular. Ischemic stroke is a classic complication of vascular Ehlers-Danlos syndrome (type IV), homocystinuria, and arterial tortuosity syndrome, and may occasionally be seen in Marfan syndrome and pseudoxanthoma elasticum with distinct underlying mechanisms for each disease. Vascular Ehlers-Danlos syndrome can also lead to cervical artery dissection (with or without ischemic stroke), carotid-cavernous fistula, intracranial dissections and aneurysms potentially causing subarachnoid or intracerebral hemorrhage, and arterial rupture. Other neurological manifestations include nerve root compression and intracranial hypotension due to dural ectasia in Marfan and Loeys-Dietz syndrome, spinal cord compression in osteogenesis imperfecta, and mucopolysaccharidosis type I and VI, carpal tunnel syndrome in mucopolysaccharidosis type I, II, and VI. Impaired mental development can be observed in homocystinuria, mucopolysaccharidosis type II, and the severe form of mucopolysaccharidosis type I. For the neurologist, being aware of these complications and of the diagnostic criteria for inherited connective tissue disorders is important since neurological complications can be the first manifestation of the disease and because caution may be warranted for the management of these patients.
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Affiliation(s)
- Stéphanie Debette
- Department of Epidemiology and Public Health, Raymond Poincaré Hospital, Garches, France; INSERM Unit U708, Pitié-Salpêtrière Hospital, Paris, France; University of Versailles - St Quentin en Yvelines, Versailles, France.
| | - Dominique P Germain
- University of Versailles - St Quentin en Yvelines, Versailles, France; Division of Medical Genetics, National Referral Center for Fabry Disease and Inherited Disorders of Connective Tissue, CHU Raymond Poincaré, Garches, France
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Khandanpour N, Connolly DJA, Raghavan A, Griffiths PD, Hoggard N. Craniospinal abnormalities and neurologic complications of osteogenesis imperfecta: imaging overview. Radiographics 2013; 32:2101-12. [PMID: 23150860 DOI: 10.1148/rg.327125716] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteogenesis imperfecta is a rare genetic disorder that leads to progressive skeletal deformities due to deficits in type I collagen, the main pathophysiologic effect of the disease. In addition, it may lead to a wide range of associated neurologic abnormalities: The central nervous system is usually involved because of softening of bone at the base of the skull, with resultant upward migration of the upper cervical spine and odontoid process into the skull base. Upward migration of the spine may cause compression of the brainstem, mechanical impingement of the spinal canal with restriction of cerebrospinal fluid circulation, and impingement of the cranial nerves. Osteogenesis imperfecta also may directly involve neurovascular structures, leading to cavernous fistulas of the carotid artery, dissection of the cervical arteries, and cerebral aneurysms. The brain parenchyma is frequently affected by the disease, with manifestations including cerebral atrophy, communicating hydrocephalus, and cerebellar hypoplasia. The imaging features of the disorder vary as widely as its clinical manifestations, depending on the severity of disease. Severe forms accompanied by debilitating skeletal fractures and progressive neurologic impairments may lead to perinatal death, whereas milder asymptomatic forms might cause only a modest reduction in life span. The most important advance in medical therapy for osteogenesis imperfecta has been the introduction of bisphosphonate therapy to slow the resorption of bone in patients with moderate to severe forms of the disease (ie, type III or IV). In some patients, neurosurgery may be necessary to correct the effects of severe basilar invagination by the odontoid process.
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Affiliation(s)
- Nader Khandanpour
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, University of Sheffield, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, England.
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Dasenbrock HH, Clarke MJ, Bydon A, Sciubba DM, Witham TF, Gokaslan ZL, Wolinsky JP. Endoscopic image-guided transcervical odontoidectomy: outcomes of 15 patients with basilar invagination. Neurosurgery 2012; 70:351-9; discussion 359-60. [PMID: 21826033 DOI: 10.1227/neu.0b013e318230e59a] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ventral decompression with posterior stabilization is the preferred treatment for symptomatic irreducible basilar invagination. Endoscopic image-guided transcervical odontoidectomy (ETO) may allow for decompression with limited morbidity. OBJECTIVE To describe the perioperative outcomes of patients undergoing anterior decompression of basilar invagination with the use of ETO. METHODS Fifteen patients who had a follow-up of at least 16 months were retrospectively reviewed. Intraoperatively, the vertebral body of C2 was removed and the odontoid was resected in a "top-down" manner using endoscopic visualization and frameless stereotactic navigation. Posterior instrumented stabilization was subsequently performed. RESULTS The average (± standard deviation) age of the patients was 42.6 ± 24.5 (range, 11-72) years. Postoperative complications occurred in 6 patients, including a urinary tract infection (n = 2), upper airway swelling (n = 2), dysphagia (n = 2), gastrostomy tube placement (n = 1), and an asymptomatic pseudomeningocele (n = 1). No patients required a tracheostomy, had bacterial meningitis, or developed a venous thromboembolic event; only 1 patient was intubated for more than 48 hours postoperatively. With a mean follow-up of 41.9 ± 14.4 (range, 16-59) months, myelopathy improved in all patients and no patient experienced late neurological deterioration. The mean modified Japanese Orthopedic Association (JOA) score increased from 11.2 ± 4.2 to 15.9 ± 1.4 (P = .002). Patients with a diagnosis other than rheumatoid arthritis or who had a higher preoperative JOA score had a significantly better postoperative neurological recovery (P = .005). CONCLUSION ETO may be a valid treatment for patients with symptomatic irreducible basilar invagination that avoids some of the morbidity of transoral surgery and leads to long-term improvement in myelopathy.
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Bettegowda C, Shajari M, Suk I, Simmons OP, Gokaslan ZL, Wolinsky JP. Sublabial approach for the treatment of symptomatic basilar impression in a patient with Klippel-Feil syndrome. Neurosurgery 2011; 69:ons77-82; discussion ons82. [PMID: 21415781 DOI: 10.1227/neu.0b013e3182160709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Basilar impression (BI) is an uncommon condition in which there is upward displacement of the elements forming the foramen magnum, causing translocation of vertebral elements into the brainstem. Most commonly a developmental anomaly, BI is often associated with congenital conditions such as Down syndrome. Symptomatic BI is often difficult to treat surgically secondary to the anatomic variants associated with many of the coinciding congenital syndromes. OBJECTIVE To present a feasible approach for the treatment of BI. METHODS We present an alternative surgical approach for the treatment of symptomatic BI in a 37-year-old woman with Klippel-Feil syndrome. Because of the altered anatomy, traditional approaches such as the transoral-transpharyngeal, transmandibular circumglossal, and transcervical endoscopic routes were not feasible. RESULTS We chose a staged sublabial, transnasal, transpalatal route for the anterior brainstem decompression followed by posterior fixation. The patient tolerated the procedures well and at last follow-up had nearly complete resolution of symptoms. CONCLUSION The sublabial route is an alternative approach for anterior decompression in patients with symptomatic basilar impression and altered anatomic circumstances such as that caused by Klippel-Feil syndrome.
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Affiliation(s)
- Chetan Bettegowda
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Cheung MS, Arponen H, Roughley P, Azouz ME, Glorieux FH, Waltimo-Sirén J, Rauch F. Cranial base abnormalities in osteogenesis imperfecta: phenotypic and genotypic determinants. J Bone Miner Res 2011; 26:405-13. [PMID: 20721936 DOI: 10.1002/jbmr.220] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cranial base abnormalities are an important complication of osteogenesis imperfecta (OI), a hereditary bone fragility disorder that in most patients is caused by mutations affecting collagen type I. To elucidate which clinical characteristics are associated with the occurrence of cranial base abnormalities in OI, we compared cephalometric results of 187 OI patients (median age 12.0 years, range 3.4 to 47 years; 96 female) with those of 191 healthy subjects and related findings to clinical descriptors of the disease. Overall, 41 patients (22%) had at least one unambiguously abnormal skull base measure. Multivariate logistic regression analysis in patients with OI types I, III, and IV (n = 169) revealed that height Z-score [odds ratio (OR) = 0.53, 95% confidence interval (CI) 0.43-0.66, p < .001]--but not age, gender, scleral hue, lumbar spine areal bone mineral density, or a history of bisphosphonate treatment--was a significant independent determinant of skull base abnormalities. Among patients with a height Z-score below -3, 48% had a skull base abnormality regardless of whether they had received bisphosphonate treatment in the first year of life or not. Genotype-phenotype correlations were evaluated in patients with detectable mutations in COL1A1 or COL1A2, the genes coding for collagen type I (n = 140). Skull base abnormalities were present in 6% of patients with haploinsufficiency (frameshift or nonsense) mutations, in 43% of patients with helical glycine substitutions caused by COL1A1 mutations, in 32% of patients with helical glycine substitutions owing to COL1A2 mutations, and in 17% of patients with splice-site mutations affecting either COL1A1 or COL1A2. However, multivariate logistic regression analysis showed that height Z-score but not the type of collagen type I mutation was independently associated with the prevalence of skull base abnormalities. In conclusion, this study shows that clinical severity of OI, as expressed by the height Z-score, was the strongest predictor of skull base abnormalities. We did not find evidence for the hypothesis that bisphosphonate treatment protects against skull base abnormalities.
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Affiliation(s)
- Moira S Cheung
- Genetics Unit, Shriners Hospital for Children, Montreal, Quebec, Canada
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Management of acute cervical compression fractures in two patients with osteogenesis imperfecta. Spine (Phila Pa 1976) 2010; 35:E1248-52. [PMID: 20881659 DOI: 10.1097/brs.0b013e3181dfcae5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We report 2 cases of acute cervical compression fracture in patients with osteogenesis imperfecta (OI). In case 1, a 15-year-old girl with an acute C6 compression fracture and additional fractures of the posterior elements underwent a C6 corpectomy and instrumented posterior fusion. In case 2, a 46-year-old man with a C7 compression fracture was managed nonoperatively. OBJECTIVE To illustrate a subset of possible acute subaxial cervical fractures in OI patients and to describe the feasibility of performing a combined anterior/posterior cervical decompression and fusion in an OI patient. SUMMARY OF BACKGROUND DATA OI is a rare genetic collagen disorder that is characterized by bone fragility and ligamentous laxity. Spinal complications associated with this disease included scoliosis, thoracolumbar compression fractures, and other spinal fractures, cervical spondyloptosis, and basilar invagination. There is limited literature that addresses the management of acute cervical spine fractures in OI patients. METHODS In case 1, the patient was initially treated with a Minerva brace. Nonoperative management was abandoned when a progressive kyphotic deformity developed. A C6 corpectomy and placement of a fibular strut allograft was followed by a C4-C7 posterior fusion with sublaminar wiring and rods. In case 2, the patient was managed nonoperatively with a rigid cervical collar alone. RESULTS In case 1, the patient made a prompt recovery, and on 12-month follow-up has maintained alignment. In case 2, the patient maintained normal alignment without need for surgical intervention. CONCLUSION A combined anterior/posterior decompression and fusion of the subaxial cervical spine is feasible in the fragile OI population. Moreover, certain isolated compression fractures of the subaxial cervical spine in this same patient population may be managed nonoperatively.
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Kaissi AA, Klaushofer K, Grill F. Distinctive tomographic abnormalities of the craniocervical region in a patient with osteogenesis imperfecta type IV B. Clinics (Sao Paulo) 2010; 65:647-9. [PMID: 20613943 PMCID: PMC2898544 DOI: 10.1590/s1807-59322010000600014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department, Hanusch Hospital - Vienna, Austria
- Orthopaedic Hospital of Speising, Paediatric Department - Vienna, Austria
- Tel.: 00 43 1 91021 86924,
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department, Hanusch Hospital - Vienna, Austria
| | - Franz Grill
- Orthopaedic Hospital of Speising, Paediatric Department - Vienna, Austria
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Osteogenesis imperfecta: Recent findings shed new light on this once well-understood condition. Genet Med 2009; 11:375-85. [DOI: 10.1097/gim.0b013e3181a1ff7b] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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