Thoracolumbar spinal abnormalities in Stickler syndrome.
METHODS
Retrospective review of clinical and radiographic records of patients with Stickler syndrome.


OBJECTIVE
To describe thoracolumbar spinal abnormalities and their correlation with age and back pain among patients with Stickler syndrome.


BACKGROUND
Stickler syndrome (hereditary arthro-ophthalmopathy) is an autosomal dominant connective tissue disorder characterized by skeletal, ocular, oral-facial, cardiac, and auditory manifestations. Prevalence is approximately 1 in 10,000 (similar to that of Marfan syndrome). No one has investigated spinal abnormalities in a large series of patients.


METHODS
A single-center evaluation of 53 patients from 24 families with Stickler syndrome (age range, 1-70 years) in a multidisciplinary genetics clinic. Thoracolumbar radiographs were analyzed for spinal abnormalities and correlation with age and back pain.


RESULTS
Thirty-four percent of patients had scoliosis, 74% endplate abnormalities, 64% Schmorl's nodes, 43% platyspondylia, and 43% Scheuermann-like kyphosis. Sixty-seven percent of patients and 85% of adults reported chronic back pain. Endplate abnormalities and Schmorl's nodes were associated with adult age; endplate abnormalities, Schmorl's nodes, and adult age were associated with back pain. Only one adult patient was free of spinal abnormalities.


CONCLUSIONS
Spinal abnormalities are nearly uniformly observed in Stickler syndrome, progress with age, and are associated with back pain. Although common, scoliosis is generally self-limited (only one patient needed surgical treatment). Correct diagnosis of this syndrome facilitates early identification and management of other potentially severe systemic manifestations and genetic counseling for affected families. Moreover, recognition of Stickler syndrome allows accurate prognosis for skeletal abnormalities and anticipation of potential surgical complications.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. peterose@mail.nih.gov
P S
PS
Rose
N U
NU
Ahn
H P
HP
Levy
U M
UM
Ahn
J
J
Davis
R M
RM
Liberfarb
L
L
Nallamshetty
P D
PD
Sponseller
C A
CA
Francomano
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000473:pathology*; D005124:Eye Abnormalities / Q000209:etiology / Q000473:pathology; D005145:Face / Q000002:abnormalities; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D012886:Skull / Q000002:abnormalities; D013904:Thoracic Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology