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2008 Young Investigator Award: The role of congenitally fused cervical segments upon the space available for the cord and associated symptoms in Klippel-Feil patients.
Spine (Phila Pa 1976). 2008 Jun 01; 33(13):1442-50.S

Abstract

STUDY DESIGN

A prospective radiographic and retrospective clinical chart review.

OBJECTIVE

This study evaluated the role of congenitally fused cervical segments in relation to the space available for the cord (SAC) and associated cervical spine-related symptoms (CSS) in patients with Klippel-Feil Syndrome (KFS).

SUMMARY OF BACKGROUND DATA

KFS is a developmental disorder presenting with congenital fusion of at least 2 cervical vertebrae. The effects of congenitally fused cervical segments in relation to the SAC and associated symptoms in KFS patients remain speculative and have not been thoroughly addressed in the literature.

METHODS

At a single institution, a prospective radiographic and clinical evaluation of 29 KFS patients was conducted. Based on plain radiographs, assessment of the SAC consisted of the posterior atlantodens interval, the midvertebral body SAC (C2-C7), and the interbody SAC (C2-C3-C7-T1). Vertebral body width (VBW) from C2 to C7 and the presence of occipitalization (O-C1) were also noted. Torg ratios were obtained at each level. Demographics, medical history, and the presence of CSS were noted based on clinical chart review.

RESULTS

Ten males and 19 females were reviewed (mean age, 13.4 years). A significant correlation was noted between the overall VBWs to the number of fused segments, age, and skeletal maturity (P < 0.05), but not to sex-type, O-C1, and SAC levels (P > 0.05). In the presence of a fused segment, individualized SAC levels tended to have greater canal dimensions and cephalad/caudal VBWs were less. Cephalad and caudal Torg ratios in relation to a segment were greater in all fused segments, and with 4 or greater fused segments (P < 0.05). Number of levels fused, sex-type, skeletal maturity, and O-C1 were not significantly associated with the presence of symptoms (P > 0.05). Symptomatic patients had smaller VBWs than nonsymptomatic patients (P = 0.027) and an overall decrease in SAC at the interbody disc level, primarily at C6-C7 (P > 0.05). Smaller Torg ratios were noted in symptomatic patients, specifically myelopathic patients.

CONCLUSION

Congenital fusion in KFS may arrest the normal vertebral development, which may affect appositional bone growth. Such effects on the VBW could potentially contribute to an increase in the SAC. Such a development may delay neurologic compromise stemming from the congenital fusion process and subsequent degenerative manifestations.

Authors+Show Affiliations

Department of Orthopaedics, Erasmus University, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18475245

Citation

Samartzis, Dino, et al. "2008 Young Investigator Award: the Role of Congenitally Fused Cervical Segments Upon the Space Available for the Cord and Associated Symptoms in Klippel-Feil Patients." Spine, vol. 33, no. 13, 2008, pp. 1442-50.
Samartzis D, Kalluri P, Herman J, et al. 2008 Young Investigator Award: The role of congenitally fused cervical segments upon the space available for the cord and associated symptoms in Klippel-Feil patients. Spine. 2008;33(13):1442-50.
Samartzis, D., Kalluri, P., Herman, J., Lubicky, J. P., & Shen, F. H. (2008). 2008 Young Investigator Award: The role of congenitally fused cervical segments upon the space available for the cord and associated symptoms in Klippel-Feil patients. Spine, 33(13), 1442-50. https://doi.org/10.1097/BRS.0b013e3181753ca6
Samartzis D, et al. 2008 Young Investigator Award: the Role of Congenitally Fused Cervical Segments Upon the Space Available for the Cord and Associated Symptoms in Klippel-Feil Patients. Spine. 2008 Jun 1;33(13):1442-50. PubMed PMID: 18475245.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2008 Young Investigator Award: The role of congenitally fused cervical segments upon the space available for the cord and associated symptoms in Klippel-Feil patients. AU - Samartzis,Dino, AU - Kalluri,Prakasam, AU - Herman,Jean, AU - Lubicky,John P, AU - Shen,Francis H, PY - 2008/5/14/pubmed PY - 2008/7/11/medline PY - 2008/5/14/entrez SP - 1442 EP - 50 JF - Spine JO - Spine VL - 33 IS - 13 N2 - STUDY DESIGN: A prospective radiographic and retrospective clinical chart review. OBJECTIVE: This study evaluated the role of congenitally fused cervical segments in relation to the space available for the cord (SAC) and associated cervical spine-related symptoms (CSS) in patients with Klippel-Feil Syndrome (KFS). SUMMARY OF BACKGROUND DATA: KFS is a developmental disorder presenting with congenital fusion of at least 2 cervical vertebrae. The effects of congenitally fused cervical segments in relation to the SAC and associated symptoms in KFS patients remain speculative and have not been thoroughly addressed in the literature. METHODS: At a single institution, a prospective radiographic and clinical evaluation of 29 KFS patients was conducted. Based on plain radiographs, assessment of the SAC consisted of the posterior atlantodens interval, the midvertebral body SAC (C2-C7), and the interbody SAC (C2-C3-C7-T1). Vertebral body width (VBW) from C2 to C7 and the presence of occipitalization (O-C1) were also noted. Torg ratios were obtained at each level. Demographics, medical history, and the presence of CSS were noted based on clinical chart review. RESULTS: Ten males and 19 females were reviewed (mean age, 13.4 years). A significant correlation was noted between the overall VBWs to the number of fused segments, age, and skeletal maturity (P < 0.05), but not to sex-type, O-C1, and SAC levels (P > 0.05). In the presence of a fused segment, individualized SAC levels tended to have greater canal dimensions and cephalad/caudal VBWs were less. Cephalad and caudal Torg ratios in relation to a segment were greater in all fused segments, and with 4 or greater fused segments (P < 0.05). Number of levels fused, sex-type, skeletal maturity, and O-C1 were not significantly associated with the presence of symptoms (P > 0.05). Symptomatic patients had smaller VBWs than nonsymptomatic patients (P = 0.027) and an overall decrease in SAC at the interbody disc level, primarily at C6-C7 (P > 0.05). Smaller Torg ratios were noted in symptomatic patients, specifically myelopathic patients. CONCLUSION: Congenital fusion in KFS may arrest the normal vertebral development, which may affect appositional bone growth. Such effects on the VBW could potentially contribute to an increase in the SAC. Such a development may delay neurologic compromise stemming from the congenital fusion process and subsequent degenerative manifestations. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/18475245/2008_Young_Investigator_Award:_The_role_of_congenitally_fused_cervical_segments_upon_the_space_available_for_the_cord_and_associated_symptoms_in_Klippel_Feil_patients_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181753ca6 DB - PRIME DP - Unbound Medicine ER -