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1.
Medicina (Kaunas) ; 60(5)2024 May 01.
Article in English | MEDLINE | ID: mdl-38792938

ABSTRACT

Klippel-Feil syndrome (KFS) is characterized by the congenital fusion of the cervical vertebrae and is sometimes accompanied by anomalies in the craniocervical junction. In basilar invagination (BI), which is a dislocation of the dens in an upper direction, compression of the brainstem and cervical cord results in neurological defects and surgery is required. A 16-year-old boy diagnosed with KFS and severe BI presented with spastic tetraplegia, opisthotonus and dyspnea. CT scans showed basilar impression, occipitalization of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Posterior occipitocervical reduction and fusion along with decompression were performed. Paralysis gradually improved postoperatively over 3 weeks. However, severe spasticity and opisthotonus persisted and intrathecal baclofen (ITB) therapy was initiated. Following this, opisthotonus disappeared and spasticity of the extremities improved. Rehabilitation therapy continued by controlling the dose of ITB. Five years after the surgery, self-propelled wheelchair driving was achieved and activities of daily life improved. The treatment strategy for patients with BI and congenital anomalies remains controversial. Posterior reduction and internal fixation using instrumentation were effective techniques in this case. Spasticity control achieved through a combination of surgery and ITB treatment enabled the amelioration of therapeutic efficacy of rehabilitation and the improvement of ADL.


Subject(s)
Baclofen , Cervical Vertebrae , Klippel-Feil Syndrome , Humans , Baclofen/therapeutic use , Baclofen/administration & dosage , Male , Klippel-Feil Syndrome/complications , Adolescent , Cervical Vertebrae/abnormalities , Cervical Vertebrae/surgery , Spinal Fusion/methods , Injections, Spinal/methods , Muscle Relaxants, Central/therapeutic use , Muscle Relaxants, Central/administration & dosage , Occipital Bone/abnormalities , Occipital Bone/surgery , Treatment Outcome , Decompression, Surgical/methods
2.
BMJ Case Rep ; 17(5)2024 May 15.
Article in English | MEDLINE | ID: mdl-38749522

ABSTRACT

The duplicated origin of the vertebral artery (VA) is an uncommon anatomical variant, which is generally identified incidentally during angiography and can be misdiagnosed as dissection in the setting of posterior circulation stroke. Here, we describe a case of the right V1 VA duplication with embryological aspects in a patient with Klippel-Feil anomaly, which was diagnosed during preoperative evaluation. Surgeons must be aware to avoid vascular injury from a duplicated VA before head-neck and spinal surgery.


Subject(s)
Klippel-Feil Syndrome , Vertebral Artery , Humans , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Vertebral Artery/abnormalities , Vertebral Artery/diagnostic imaging , Male , Adult , Computed Tomography Angiography , Female
3.
Orphanet J Rare Dis ; 19(1): 141, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38561822

ABSTRACT

BACKGROUND: Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of two or more cervical vertebrae during early prenatal development. This fusion results from a failure of segmentation during the first trimester. Although six genes have previously been associated with KFS, they account for only a small proportion of cases. Among the distinct subtypes of KFS, "sandwich fusion" involving concurrent fusion of C0-1 and C2-3 vertebrae is particularly noteworthy due to its heightened risk for atlantoaxial dislocation. In this study, we aimed to investigate novel candidate mutations in patients with "sandwich fusion." METHODS: We collected and analyzed clinical data from 21 patients diagnosed with "sandwich fusion." Whole-exome sequencing (WES) was performed, followed by rigorous bioinformatics analyses. Our focus was on the six known KFS-related genes (GDF3, GDF6, MEOX1, PAX1, RIPPLY2, and MYO18). Suspicious mutations were subsequently validated through in vitro experiments. RESULTS: Our investigation revealed two novel exonic mutations in the FGFR2 gene, which had not previously been associated with KFS. Notably, the c.1750A > G variant in Exon 13 of FGFR2 was situated within the tyrosine kinase domain of the protein, in close proximity to several established post-translational modification sites. In vitro experiments demonstrated that this certain mutation significantly impacted the function of FGFR2. Furthermore, we identified four heterozygous candidate variants in two genes (PAX1 and MYO18B) in two patients, with three of these variants predicted to have potential clinical significance directly linked to KFS. CONCLUSIONS: This study encompassed the largest cohort of patients with the unique "sandwich fusion" subtype of KFS and employed WES to explore candidate mutations associated with this condition. Our findings unveiled novel variants in PAX1, MYO18B, and FGFR2 as potential risk mutations specific to this subtype of KFS.


Subject(s)
Klippel-Feil Syndrome , Humans , Klippel-Feil Syndrome/genetics , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Exome Sequencing , Mutation/genetics , Receptor, Fibroblast Growth Factor, Type 2/genetics
4.
Medicina (Kaunas) ; 60(4)2024 Apr 10.
Article in English | MEDLINE | ID: mdl-38674263

ABSTRACT

Objectives and Background: To present a novel technique of treatment for a patient with basilar invagination. Basilar invagination (BI) is a congenital condition that can compress the cervicomedullary junction, leading to neurological deficits. Severe cases require surgical intervention, but there is debate over the choice of approach. The anterior approach allows direct decompression but carries high complication rates, while the posterior approach provides indirect decompression and offers good stability with fewer complications. Materials and Methods: A 15-year-old boy with severe myelopathy presented to our hospital with neck pain, bilateral upper limb muscle weakness, and hand numbness persisting for 4 years. Additionally, he experienced increased numbness and gait disturbance three months before his visit. On examination, he exhibited hyperreflexia in both upper and lower limbs, muscle weakness in the bilateral upper limbs (MMT 4), bilateral hypoesthesia below the elbow and in both legs, mild urinary and bowel incontinence, and a spastic gait. Radiographs revealed severe basilar invagination (BI). Preoperative images showed severe BI and that the spinal cord was severely compressed with odontoid process. Results: The patient underwent posterior surgery with the C-arm free technique. All screws including occipital screws were inserted into the adequate position under navigation guidance. Reduction was achieved with skull rotation and distraction. A follow-up at one year showed the following results: Manual muscle testing results and sensory function tests showed almost full recovery, with bilateral arm recovery (MMT 5) and smooth walking. The cervical Japanese Orthopedic Association score of the patient improved from 9/17 to 16/17. Postoperative images showed excellent spinal cord decompression, and no major or severe complications had occurred. Conclusions: Basilar invagination alongside Klippel-Feil syndrome represents a relatively uncommon condition. Utilizing a posterior approach for treating reducible BI with a C-arm-free technique proved to be a safe method in addressing severe myelopathy. This novel navigation technique yields excellent outcomes for patients with BI.


Subject(s)
Decompression, Surgical , Klippel-Feil Syndrome , Humans , Male , Adolescent , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/surgery , Decompression, Surgical/methods , Platybasia/complications , Platybasia/surgery , Treatment Outcome , Spinal Cord Compression/surgery , Spinal Cord Compression/etiology
5.
Tex Heart Inst J ; 51(1)2024 Apr 26.
Article in English | MEDLINE | ID: mdl-38665003

ABSTRACT

Klippel-Feil syndrome, characterized by congenital fusion of any 2 or more cervical vertebrae, is a rare disorder in which skeletal and other organ system-related abnormalities have been reported. This article reports a case of mitral valve regurgitation in a patient with Klippel-Feil syndrome and related thoracic deformity who underwent mitral valvuloplasty. Postoperatively, the mitral valve regurgitation disappeared, and there has been no recurrence for 3 years. This case highlights mitral valvuloplasty via median sternotomy as an excellent treatment for mitral valve regurgitation in a patient with thoracic deformity related to Klippel-Feil syndrome.


Subject(s)
Klippel-Feil Syndrome , Mitral Valve Insufficiency , Adult , Humans , Male , Balloon Valvuloplasty , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Klippel-Feil Syndrome/surgery , Mitral Valve/surgery , Mitral Valve/abnormalities , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/diagnosis , Sternotomy , Tomography, X-Ray Computed , Treatment Outcome
6.
J Med Case Rep ; 18(1): 211, 2024 Apr 28.
Article in English | MEDLINE | ID: mdl-38678290

ABSTRACT

BACKGROUND: Sprengel's deformity is a congenital abnormality of the shoulder girdle. Because scapular retraction, such as the Green procedure, is usually performed during childhood to improve esthetics and shoulder function, Sprengel's deformity is rarely found in older patients. CASE PRESENTATION: We presented a unique case of a Japanese female cadaver with Sprengel's deformity at the age of 80 years. Anatomical dissection and radiological imaging revealed musculoskeletal anomalies associated with Sprengel's deformity, including Klippel-Feil syndrome, presence of an omovertebral bone, and absence of the trapezius muscle. In addition, bilateral cervical ribs were in contact with the brachial plexus. These anomalies may lead to numbness, pain, and limited range of motion of the neck and upper girdle with aging. CONCLUSIONS: Because most adult patients with Sprengel's deformity experience neck pain and limited movement of the shoulder, the presented case is a rare case of neglected Sprengel's deformity in an 80-year-old cadaver.


Subject(s)
Cadaver , Scapula , Scapula/abnormalities , Shoulder Joint/abnormalities , Humans , Female , Aged, 80 and over , Scapula/diagnostic imaging , Klippel-Feil Syndrome/complications , Congenital Abnormalities/diagnostic imaging , Brachial Plexus/abnormalities , Brachial Plexus/diagnostic imaging
7.
J Med Case Rep ; 18(1): 137, 2024 Mar 06.
Article in English | MEDLINE | ID: mdl-38444009

ABSTRACT

BACKGROUND: Klippel-Feil syndrome is a rare congenital bone disorder characterized by an abnormal fusion of two or more cervical spine vertebrae. Individuals with Klippel-Feil syndrome exhibit diverse clinical manifestations, including skeletal irregularities, visual and hearing impairments, orofacial anomalies, and anomalies in various internal organs, such as the heart, kidneys, genitourinary system, and nervous system. CASE PRESENTATION: This case report describes a 12-year-old Pashtun female patient who presented with acute bilateral visual loss. The patient had Klippel-Feil syndrome, with the typical clinical triad symptoms of Klippel-Feil syndrome, along with Sprengel's deformity. She also exhibited generalized hypoalgesia, which had previously resulted in widespread burn-related injuries. Upon examination, bilateral optic disc swelling was observed, but intracranial pressure was found to be normal. Extensive investigations yielded normal results, except for hypocalcemia and low vitamin D levels, while parathyroid function remained within the normal range. Visual acuity improved following 2 months of calcium and vitamin D supplementation, suggesting that the visual loss and optic nerve swelling were attributed to hypocalcemia. Given the normal parathyroid function, it is possible that hypocalcemia resulted from low vitamin D levels, which can occur after severe burn scarring. Furthermore, the patient received a provisional diagnosis of congenital insensitivity to pain on the basis of the detailed medical history and the findings of severe and widespread loss of the ability to perceive painful stimuli, as well as impaired temperature sensation. However, due to limitations in genetic testing, confirmation of the congenital insensitivity to pain diagnosis could not be obtained. CONCLUSION: This case highlights a rare presentation of transient binocular vision loss and pain insensitivity in a patient with Klippel-Feil syndrome, emphasizing the importance of considering unusual associations in symptom interpretation.


Subject(s)
Hypocalcemia , Klippel-Feil Syndrome , Pain Insensitivity, Congenital , Female , Humans , Child , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Vision, Binocular , Pain , Cervical Vertebrae , Vitamin D
8.
Spec Care Dentist ; 44(1): 89-95, 2024.
Article in English | MEDLINE | ID: mdl-36670527

ABSTRACT

BACKGROUND: Klippel-Fiel syndrome (KFS) is a rare congenital skeletal disorder characterized clinically by presence of a triad of short neck, limited neck mobility (due to fused cervical vertebrae) and low posterior hair line. It was first described by Maurice Klippel and Andre Feil in 1912. Various skeletal and non-skeletal anomalies may be seen in association with KFS. CASE PRESENTATION: This report aims to highlight orofacial manifestations of a 16-year-old male patient with KFS along with a rare presentation of bilateral osteoarthritic changes in the temporomandibular joint. The treatment planning and execution for such a case has also been described. CONCLUSION: Bilateral osteoarthritic changes of temporomandibular joint have been rarely reported in KFS. This report emphasizes that early diagnosis of various associated anomalies and timely intervention through an interdisciplinary approach is very essential in the management of patients with KFS.


Subject(s)
Klippel-Feil Syndrome , Osteoarthritis , Male , Humans , Adolescent , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Osteoarthritis/complications , Temporomandibular Joint
9.
Childs Nerv Syst ; 40(2): 581-586, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37897525

ABSTRACT

BACKGROUND: Chiari malformation type III (CM III), a rare hindbrain anomaly, often presents with various concurrent anomalies. This paper reports a unique case of CM III associated with Klippel-Feil syndrome (KFS), a condition previously unreported in Saudi Arabia and documented in only one other case globally in Turkey. This study aims to share insights into the unusual association between CM III and KFS, considering their close embryological development and involvement in the craniocervical junction. METHODOLOGY: The study presents a case of a 2.5-year-old female diagnosed with CM III and KFS. Diagnostic tools such as ultrasound, CT scans, MRI, and physical examinations were used to confirm the patient's condition. Surgical interventions, including decompression and encephalocele repair, were performed. RESULTS: Successful surgical interventions, including encephalocele repair and duraplasty, were carried out. Follow-up visits indicated a stable condition, marked improvement in lower limb strength, and the patient's ability to walk with assistance. CT follow-up affirmed a satisfactory surgical outcome. CONCLUSION: This case study illustrates the potential for an optimistic prognosis in CM III, even when accompanied by complex conditions such as KFS, through early diagnosis and intervention. It underscores the significance of antenatal screening for effective care planning and calls for further research and publications due to the rarity of this association. These findings contribute to our understanding of CM III and its related conditions, emphasizing the need for open-minded consideration of potential embryological associations.


Subject(s)
Arnold-Chiari Malformation , Klippel-Feil Syndrome , Pregnancy , Humans , Female , Child, Preschool , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnostic imaging , Klippel-Feil Syndrome/surgery , Encephalocele , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/diagnostic imaging , Arnold-Chiari Malformation/surgery , Tomography, X-Ray Computed , Magnetic Resonance Imaging
10.
J Med Case Rep ; 17(1): 528, 2023 Dec 23.
Article in English | MEDLINE | ID: mdl-38135884

ABSTRACT

BACKGROUND: Klippel-Feil syndrome is a rare condition described in 1912 by Maurice Klippel and André Feil. It is defined as a congenital cervical fusion of at least two vertebrae, associated with a classical triad of clinical signs: short neck, low posterior hairline, and limited range of movement. However, Klippel-Feil syndrome manifests with a vast spectrum of phenotypes, ranging from no symptoms to complete triad, with or without other associated malformations. Most commonly, CCF results from sporadic mutations, even though autosomal recessive, autosomal dominant, or even X-linked inheritance can be detected. The ATP-binding cassette subfamily B member 4 is only expressed in the liver and is involved in biliary phospholipid secretion. The clinical spectrum includes various hepatobiliary pathologies, including low phospholipid-associated cholelithiasis, and has never been associated with musculoskeletal anomalies. CASE PRESENTATION: A 55-year-old male Caucasian patient presenting with low phospholipid-associated cholelithiasis syndrome with ATP-binding cassette subfamily B member 4 mutation and liver cirrhosis was referred to our clinic for a liver transplant. A period of 6 months before, the patient underwent a T7-T9 posterior fixation for a T8 osteoporotic fracture. Postoperatively, he was tetraparetic, whereas he was neurologically intact before the operation. At admission to our hospital, he was still tetraparetic and presented with clinical signs of cervical myelopathy. Moreover, he suffered a limitation of cervical range of motion in all directions, short neck, and low posterior hairline. Imaging showed multiple cervical and thoracic vertebral bodies fusion, as well as cervical spine stenosis. Based on the available data, we diagnosed a type 3 Klippel-Feil syndrome according to Samartzis' classification. CONCLUSIONS: The heterogeneity of KFS and the various potential hereditary links that are known indicate that it is important to highlight all potential cases related to known genetic defects. At present, no association between ATP-binding cassette subfamily B member 4 mutation and congenital cervical fusions has been reported. The other important clinical focus of this case is the appearance of spontaneous tetraparesis after thoracic spine surgery. This mechanism remains unclear, but considering different spinal anatomy it might have been due to difficult intubation and patient's positioning during his previous operation.


Subject(s)
Cholelithiasis , Klippel-Feil Syndrome , Male , Humans , Middle Aged , Klippel-Feil Syndrome/genetics , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Cervical Vertebrae/surgery , Mutation , Cholelithiasis/complications , Phospholipids , Adenosine Triphosphate
11.
BMC Musculoskelet Disord ; 24(1): 722, 2023 Sep 11.
Article in English | MEDLINE | ID: mdl-37697343

ABSTRACT

BACKGROUND: There are some cases of Klippel-Feil syndrome with spinal cord injury in clinical work. However, there is no literature report on Brown-Sequard syndrome after trauma. We report a case of Brown-Sequard syndrome following minor trauma in a patient with KFS type III. Her Brown-Sequard syndrome is caused by Klippel-Feil syndrome. CASE PRESENTATION: We found a 38-year-old female patient with KFS in our clinical work. She was unconscious on the spot following a minor traumatic episode. After treatment, her whole body was numb and limb activity was limited. Half an hour later, she felt numb and weak in the right limb and weak in the left limb. She had no previous hypertension, diabetes, or coronary heart disease. After one-month treatment of medication, hyperbaric oxygen, rehabilitation, and acupuncture in our hospital, her muscle strength partially recovered, but the treatment effect was still not satisfactory. Then, she underwent surgical treatment and postoperative comprehensive treatment, and rehabilitation training. She was able to take care of herself with assistance, and her condition improved from grade B to grade D according to the ASIA (ASIA Impairment Scale) classification. CONCLUSION: KFS, also known as short neck deformity, is a kind of congenital deformity characterized by impaired formation and faulty segmentation of the cervical spine, often associated with abnormalities of other organs. The cervical deformity in patients with KFS can alter the overall mechanical activity of the spine, as well as the compensatory properties of the spine for decelerating and rotatory forces, thus increasing the chance of spinal cord injury (SCI) following trauma. Many mechanisms can make patients more susceptible to injury. Increased range of motion of the segment adjacent to the fused vertebral body may lead to slippage of the adjacent vertebral body and altered disc stress, as well as cervical instability. SCI can result in complete or incomplete impairment of motor, sensory and autonomic nervous functions below the level of lesion. This woman presented with symptoms of BSS, a rare neurological disorder with incomplete SCI. Judging from the woman's symptoms, we concluded that previously she had KFS, which resulted in SCI without fracture and dislocation following minor trauma, with partial BSS. After the comprehensive treatment of surgery, hyperbaric oxygen, rehabilitation therapy, and neurotrophic drugs, two years later, we found her symptoms significantly improved, with ASIA Impairment Scale from grade B to grade D, and her ability to perform activities of daily living with aids.


Subject(s)
Brown-Sequard Syndrome , Klippel-Feil Syndrome , Spinal Cord Injuries , Humans , Female , Adult , Klippel-Feil Syndrome/complications , Brown-Sequard Syndrome/diagnostic imaging , Brown-Sequard Syndrome/etiology , Brown-Sequard Syndrome/surgery , Activities of Daily Living , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery
13.
Adv Tech Stand Neurosurg ; 46: 125-147, 2023.
Article in English | MEDLINE | ID: mdl-37318573

ABSTRACT

Weakness of the muscles of the nape of the neck and back of the spine and its related instability is the nodal point of pathogenesis of a number of clinical and pathological events at the craniovertebral junction and the spine. Whilst acute instability results in sudden and relatively severe symptoms, chronic or long-standing instability is associated with a range of musculoskeletal and structural spinal alterations. Telescoping of the spinal segments results in "vertical" spinal instability in the subaxial spine and central or axial atlantoaxial instability (CAAD) at the craniovertebral junction. Instability in such cases might not be observed on dynamic radiological imaging. Chiari formation, basilar invagination, syringomyelia, and Klippel-Feil alteration are some of the secondary alterations as a result of chronic atlantoaxial instability. Radiculopathy/myelopathy related to spinal degeneration or ossification of posterior longitudinal ligament appears to have their origin from vertical spinal instability. All the secondary alterations in the craniovertebral junction and subaxial spine that are traditionally considered pathological and to have compressive and deforming role are essentially protective in nature, are indicative of instability, and are potentially reversible following atlantoaxial stabilization. Stabilization of unstable spinal segments is the basis of surgical treatment.


Subject(s)
Atlanto-Axial Joint , Joint Instability , Klippel-Feil Syndrome , Spinal Diseases , Syringomyelia , Humans , Atlanto-Axial Joint/diagnostic imaging , Joint Instability/diagnostic imaging , Syringomyelia/diagnostic imaging , Klippel-Feil Syndrome/complications , Spinal Diseases/complications , Cervical Vertebrae/surgery
14.
Oper Neurosurg (Hagerstown) ; 25(2): 117-124, 2023 08 01.
Article in English | MEDLINE | ID: mdl-37219571

ABSTRACT

BACKGROUND: Few studies have described a transmandibular approach for decompression in a patient with Klippel-Feil syndrome (KFS) for cervical myelopathy. OBJECTIVE: To describe the transmandibular approach in a KFS patient with cervical myelopathy and to perform a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase and PubMed databases were searched from January 2002 to November 2022 for articles examining patients with KFS undergoing cervical decompression and/or fusion for cervical myelopathy and/or radiculopathy were included. Articles describing compression due to nonbony causes, lumbar/sacral surgery, nonhuman studies, or symptoms only from basilar invagination/impression were excluded. Data collected were sex, median age, Samartzis type, surgical approach, and postoperative complications. RESULTS: A total of 27 studies were included, with 80 total patients. Thirty-three patients were female, and the median age ranged from 9 to 75 years. Forty-nine patients, 16 patients, and 13 patients were classified as Samartzis Types I, II, and III, respectively. Forty-five patients, 21 patients, and 6 patients underwent an anterior, posterior, and combined approach, respectively. Five postoperative complications were reported. One article reported a transmandibular approach for access to the cervical spine. CONCLUSION: Patients with KFS are at risk of developing cervical myelopathy. Although KFS manifests heterogeneously and may be treated through a variety of approaches, some manifestations of KFS may preclude traditional approaches for decompression. Surgical exposure through the anterior mandible may prove an option for cervical decompression in patients with KFS.


Subject(s)
Klippel-Feil Syndrome , Spinal Cord Compression , Spinal Cord Diseases , Humans , Female , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Male , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/surgery , Spinal Cord Compression/complications , Spinal Cord Compression/surgery , Cervical Vertebrae/surgery , Spinal Cord Diseases/surgery , Postoperative Complications
16.
JNMA J Nepal Med Assoc ; 61(266): 819-821, 2023 Oct 01.
Article in English | MEDLINE | ID: mdl-38289771

ABSTRACT

Klippel-Feil syndrome is a rare congenital bone disorder characterised by a triad of short neck, low posterior hairline and limited lateral bending of the neck with an annual incidence of 1 in 40,000 live births. It has remained an obscure term in the medical literature because of its variability in presentation and wide spectrum of anomalies involving multiple organ systems. It is unusual to find a case that has all three classical triad features. Here, we present a case of a 9-month-old infant who manifests not only all three classical triad features associated with Klippel-Feil syndrome but also demonstrates the presence of congenital heart disease, scoliosis, and renal ectopia. An early comprehensive evaluation of a suspected case is essential for diagnosis and counselling which impacts its prognosis, helps minimize social stigma and affords parents the opportunity to consider cosmetic surgery as an option, should they choose to pursue it. Keywords: case reports; congenital; heart diseases; Klippel-Feil syndrome; scoliosis.


Subject(s)
Heart Defects, Congenital , Klippel-Feil Syndrome , Scoliosis , Infant , Humans , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Scoliosis/complications , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Bone and Bones , Kidney/abnormalities , Rare Diseases/complications
17.
J Ayub Med Coll Abbottabad ; 34(3): 573-577, 2022.
Article in English | MEDLINE | ID: mdl-36377179

ABSTRACT

Klippel-Feil syndrome (KFS) is the congenital fusion of two or more cervical vertebrae which is often associated with various other abnormalities in the cervical spine. Involvement the upper cervical segments leads to atlanto-axial instability which manifests as progressive neurological symptoms due to compression on the spinal cord. These cases pose a surgical challenge due the abnormal and unique anatomy of each patient. A 37-year-old patient presented with neck pain and cervical myelopathy due to a posterior subluxation of C2-3 fused segment over C4-6 fused segment. The patient had an os odontoideum, incomplete posterior arch of C1, anomalous course of vertebral artery and C3 hemi-vertebra. The patient was successfully managed with transoral odontoidectomy and occipeto-cervical fusion. Irreducible atlanto-axial dislocation in a patient with an abnormal upper cervical spine anatomy may require transoral decompression followed by posterior fusion.


Subject(s)
Atlanto-Axial Joint , Axis, Cervical Vertebra , Joint Dislocations , Klippel-Feil Syndrome , Spinal Fusion , Humans , Adult , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/surgery , Atlanto-Axial Joint/diagnostic imaging , Atlanto-Axial Joint/surgery , Axis, Cervical Vertebra/abnormalities , Axis, Cervical Vertebra/surgery , Joint Dislocations/complications , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Cervical Vertebrae/surgery
18.
J Orthop Surg Res ; 17(1): 495, 2022 Nov 16.
Article in English | MEDLINE | ID: mdl-36384627

ABSTRACT

OBJECTIVE: This study aims to investigate the clinical application and feasibility of C2 subfacetal screws in patients with Klippel-Feil syndrome (KFS), narrow C2 pedicles, and high-riding vertebral arteries (HRVAs). METHODS: The clinical data of seven patients with KFS, atlantoaxial dislocation, narrow C2 pedicles, and HRVAs treated with C2 subfacetal screws were analyzed in this retrospective study. The internal height, isthmus height, and pedicle width of C2 vertebra were measured using preoperative computed tomography (CT). Subfacetal screws were inserted for 7 patients (12 sides). The position and length of the screws were observed using postoperative CT. Intraoperative dura mater and vertebral artery (VA) injuries were recorded. Bone fusion was observed using follow-up CT. RESULTS: The internal height was 10.5 ± 3.2 mm, the isthmus height was 3.7 ± 1.8 mm, the pedicle width was 3.0 ± 1.4 mm, and the screw length was 19.7 ± 1.5 mm. All patients had HRVAs and narrow pedicles. No injury to the dura mater and vertebral artery (VA) occurred in this group of patients. Bone fusion was achieved in all patients during follow-up. CONCLUSIONS: In patients with KFS, HRVA, and a narrow C2 pedicle, there is sufficient space below the C2 articular surface for screw insertion. When the pedicle is narrow and the C2 pedicle screw is not suitable for placement due to possible injury to the VA, subfacetal screws are a feasible alternative.


Subject(s)
Joint Dislocations , Klippel-Feil Syndrome , Pedicle Screws , Spinal Fusion , Humans , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgery , Vertebral Artery/injuries , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnostic imaging , Klippel-Feil Syndrome/surgery , Retrospective Studies , Spinal Fusion/methods , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(6): 739-744, 2022 Jun 15.
Article in Chinese | MEDLINE | ID: mdl-35712932

ABSTRACT

Objective: To introduce a new occipitocervical angle parameter, occipito-odontoid angle (O-Da), for predicting dysphagia after occipitocervical fusion (OCF) in patients with C 2, 3 Klippel-Feil syndrome (KFS) and analyze its effectiveness. Methods: A total of 119 patients met selective criteria between April 2010 and November 2019 were retrospectively included as the study subjects. There were 56 males and 63 females. The age ranged from 14 to 76 years, with a median age of 51 years. There were 44 cases of basilar invagination and 75 cases of atlantoaxial subluxation. Forty patients were combined with C 2, 3 KFS. Seven patients underwent anterior decompression combined with posterior OCF and 112 patients underwent posterior OCF. The fixed segments were O-C 2 in 36 cases, O-C 3 in 51 cases, O-C 4 in 25 cases, and O-C 5 in 7 cases. All patients were followed up 21-136 months, with a median time of 79 months. The lateral cervical X-ray films before operation and at last follow-up were used to measure the occipital to C 2 angle (O-C 2a), the occipital and external acoustic meatus to axis angle (O-EAa), the occipital protuberance to axial angle (Oc-Axa), the O-Da, and the narrowest oropharyngeal airway space (nPAS). The differences of the above parameters between the last follow-up and the preoperative values were calculated (represented as dO-C 2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS). Patients were divided into two groups according to whether they suffered dysphagia after operation, and the differences in clinical data and radiographic parameters were compared between the two groups. The correlation between occipitocervical angle parameters and nPAS in 40 patients with C 2, 3 KFS was analyzed respectively. In addition, sensitivity and specificity analyses were used to assess the effectiveness of dO-Da≤-5° for the prediction of postoperative dysphagia. Results: Thirty-one patients (26.1%) suffered dysphagia after OCF (dysphagia group), including 10 patients with C 2, 3 KFS; no dysphagia occurred in 88 patients (non-dysphagia group). There was no significant difference in age, follow-up time, fixed segment, proportion of patients with rheumatoid arthritis, proportion of patients with atlantoaxial subluxation, and proportion of patients with C 2, 3 KFS between the two groups ( P>0.05). The proportion of female patients was significantly higher in dysphagia group than in non-dysphagia group ( χ 2=7.600, P=0.006). The difference in preoperative O-C 2a between the two groups was significant ( t=2.528, P=0.014). No significant differences were observed in preoperative O-EAa, Oc-Axa, O-Da, and nPAS ( P>0.05). There was no significant difference in dO-C 2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS between the two groups ( P>0.05). The dO-C 2a, dO-EAa, dOc-Axa, and dO-Da were positively correlated with dnPAS in 40 patients with C 2, 3 KFS ( r=0.604, P<0.001; r=0.649, P<0.001; r=0.615, P<0.001; r=0.672, P<0.001). Taking dO-Da≤-5° as the standard, the sensitivity and specificity of dO-Da to predict postoperative dysphagia in patients with C 2, 3 KFS were 80.0% (8/10) and 93.3% (28/30), respectively. Conclusion: The dO-Da is a reliable indicator for predicting dysphagia after OCF in patients with C 2, 3 KFS.


Subject(s)
Deglutition Disorders , Joint Dislocations , Klippel-Feil Syndrome , Odontoid Process , Spinal Fusion , Adolescent , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Deglutition Disorders/etiology , Female , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/surgery , Male , Middle Aged , Retrospective Studies , Young Adult
20.
J Stroke Cerebrovasc Dis ; 31(5): 106399, 2022 May.
Article in English | MEDLINE | ID: mdl-35228024

ABSTRACT

OBJECTIVES: To describe the case of an ischemic stroke patient with Klippel-Feil syndrome who developed multiple aneurysms and discuss the mechanism of aneurysm development. MATERIALS AND METHODS: A 44-year-old man presented with dizziness, left hemiparesis, and left-sided numbness and was admitted to our department. He developed multiple aneurysms at the bilateral vertebral artery (VA) and bilateral internal carotid artery. RESULTS: We diagnosed the etiology of his brain infarction as an embolic stroke caused by left VA dissection or the large thrombosed aneurysm. Furthermore, we considered that arterial dissection or Hox gene mutation was associated with the development of multiple aneurysms. CONCLUSION: While previous reports have described single aneurysm, this is the first report of multiple aneurysms associated with Klippel-Feil syndrome.


Subject(s)
Ischemic Stroke , Klippel-Feil Syndrome , Vertebral Artery Dissection , Adult , Carotid Artery, Internal , Humans , Klippel-Feil Syndrome/complications , Klippel-Feil Syndrome/diagnosis , Male , Vertebral Artery , Vertebral Artery Dissection/complications
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