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Spinal cord dimensions in children with Klippel-Feil syndrome: a controlled, blinded radiographic analysis with implications for neurologic outcomes.
Spine (Phila Pa 1976) 2008; 33(12):1366-71S

Abstract

STUDY DESIGN

Retrospective case series.

OBJECTIVE

To evaluate the axial cross-sectional dimensions of the spinal cord and cerebrospinal fluid (CSF) column in children with Klippel-Feil Syndrome (KFS) versus an age-matched cohort of control subjects.

SUMMARY OF BACKGROUND DATA

Neurologic sequelae and chronic pain are known to occur in KFS and factors implicated include spinal cord compression from canal stenosis, segmental instability, vascular disruption, and central nervous system abnormalities including tethered cord, syrinx, and diastomyelia. No study to date, however, has examined the role of spinal cord size as a contributing factor to neurologic sequelae in KFS.

METHODS

We retrospectively reviewed the plain radiographic, magnetic resonance imaging (MRI), and clinical records of 12 consecutive patients between 2 and 18 years with KFS (average age 9.5 +/- 5.3 years) and 14 age-matched controls (average age 8.3 +/- 5.1 year). For each patient, plain film radiography was reviewed to compare Torg ratios at each cervical level, and axial T1-weighted MRI was used to compare spinal cord and CSF column cross-sectional area calculations.

RESULTS

The Torg-Pavlov ratios were identical between the 2 groups (0.77 +/- 0.15 vs. 0.77 +/- 0.19). Analysis of axial T1-weighted MRI cross-sectional spinal cord area revealed that the cord was smaller in KFS patients at each level from C2-C7 compared with controls. These differences were statistically significant at C4 (P = 0.016), C5 (P = 0.035), and C6 (P = 0.032). Subset analysis of abnormal (fused) levels compared with controls revealed the same findings, although these differences were not significant due to the limited numbers available at each level. Analysis of the CSF column, however, revealed that overall the canal was slightly larger in KFS patients compared with controls, although this difference was not statistically significant. Four of the 12 KFS patients presented with neurologic symptoms, all of which improved after posterior cervical stabilization.

CONCLUSION

In our cohort of patients we have noted statistically significant differences in axial cord dimensions, with no differences in CSF column, suggesting that the cord size is smaller in KFS children compared with age-matched controls.

Authors+Show Affiliations

Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA 19104-4399, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18496350

Citation

Auerbach, Joshua D., et al. "Spinal Cord Dimensions in Children With Klippel-Feil Syndrome: a Controlled, Blinded Radiographic Analysis With Implications for Neurologic Outcomes." Spine, vol. 33, no. 12, 2008, pp. 1366-71.
Auerbach JD, Hosalkar HS, Kusuma SK, et al. Spinal cord dimensions in children with Klippel-Feil syndrome: a controlled, blinded radiographic analysis with implications for neurologic outcomes. Spine. 2008;33(12):1366-71.
Auerbach, J. D., Hosalkar, H. S., Kusuma, S. K., Wills, B. P., Dormans, J. P., & Drummond, D. S. (2008). Spinal cord dimensions in children with Klippel-Feil syndrome: a controlled, blinded radiographic analysis with implications for neurologic outcomes. Spine, 33(12), pp. 1366-71. doi:10.1097/BRS.0b013e3181732a22.
Auerbach JD, et al. Spinal Cord Dimensions in Children With Klippel-Feil Syndrome: a Controlled, Blinded Radiographic Analysis With Implications for Neurologic Outcomes. Spine. 2008 May 20;33(12):1366-71. PubMed PMID: 18496350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal cord dimensions in children with Klippel-Feil syndrome: a controlled, blinded radiographic analysis with implications for neurologic outcomes. AU - Auerbach,Joshua D, AU - Hosalkar,Harish S, AU - Kusuma,Sharat K, AU - Wills,Brian P D, AU - Dormans,John P, AU - Drummond,Denis S, PY - 2008/5/23/pubmed PY - 2008/7/4/medline PY - 2008/5/23/entrez SP - 1366 EP - 71 JF - Spine JO - Spine VL - 33 IS - 12 N2 - STUDY DESIGN: Retrospective case series. OBJECTIVE: To evaluate the axial cross-sectional dimensions of the spinal cord and cerebrospinal fluid (CSF) column in children with Klippel-Feil Syndrome (KFS) versus an age-matched cohort of control subjects. SUMMARY OF BACKGROUND DATA: Neurologic sequelae and chronic pain are known to occur in KFS and factors implicated include spinal cord compression from canal stenosis, segmental instability, vascular disruption, and central nervous system abnormalities including tethered cord, syrinx, and diastomyelia. No study to date, however, has examined the role of spinal cord size as a contributing factor to neurologic sequelae in KFS. METHODS: We retrospectively reviewed the plain radiographic, magnetic resonance imaging (MRI), and clinical records of 12 consecutive patients between 2 and 18 years with KFS (average age 9.5 +/- 5.3 years) and 14 age-matched controls (average age 8.3 +/- 5.1 year). For each patient, plain film radiography was reviewed to compare Torg ratios at each cervical level, and axial T1-weighted MRI was used to compare spinal cord and CSF column cross-sectional area calculations. RESULTS: The Torg-Pavlov ratios were identical between the 2 groups (0.77 +/- 0.15 vs. 0.77 +/- 0.19). Analysis of axial T1-weighted MRI cross-sectional spinal cord area revealed that the cord was smaller in KFS patients at each level from C2-C7 compared with controls. These differences were statistically significant at C4 (P = 0.016), C5 (P = 0.035), and C6 (P = 0.032). Subset analysis of abnormal (fused) levels compared with controls revealed the same findings, although these differences were not significant due to the limited numbers available at each level. Analysis of the CSF column, however, revealed that overall the canal was slightly larger in KFS patients compared with controls, although this difference was not statistically significant. Four of the 12 KFS patients presented with neurologic symptoms, all of which improved after posterior cervical stabilization. CONCLUSION: In our cohort of patients we have noted statistically significant differences in axial cord dimensions, with no differences in CSF column, suggesting that the cord size is smaller in KFS children compared with age-matched controls. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/18496350/Spinal_cord_dimensions_in_children_with_Klippel_Feil_syndrome:_a_controlled_blinded_radiographic_analysis_with_implications_for_neurologic_outcomes_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3181732a22 DB - PRIME DP - Unbound Medicine ER -