title: Scoliosis in Children With Aicardi Syndrome.
abstract: BACKGROUND
  Aicardi syndrome (ACS) is a rare neurodevelopmental disorder that was classically characterized by the triad of agenesis of corpus callosum, infantile spasms, and chorioretinal lacunae. As new cases emerge and new common phenotypic features are being described in subsequent reports, new modified diagnostic criteria have been proposed that now classify the observed costovertebral abnormalities as supporting diagnostic features. To our knowledge there are no previous studies focusing and describing the scoliosis observed in children with ACS.
  
  
  METHODS
  We screened billing lists to identify patients seen in the Division of Orthopaedic Surgery at our institution with a diagnosis of ACS that were treated for scoliosis after 2001. A total of 5 patients were identified. Medical records and radiographs were retrospectively reviewed in all cases. In all of the patients the diagnosis of ACS had been confirmed through complete genetic evaluation and advanced imaging.
  
  
  RESULTS
  The mean age when scoliosis was first noticed was 3.9±4.2 years (range, 0.5 to 10.5 y) with a mean Cobb angle of 22.5±6.7 degrees (range, 10 to 27 degrees). The mean age at the first orthopedic visit was 5.8±5.0 years (range, 1.5 to 13 y) with a progressed mean Cobb angle of 39.5±17.3 degrees (range, 15 to 57 degrees). Congenital vertebral anomalies were observed in 1 patient. Three patients were treated surgically; 1 of the 3 patients had a surgical complication with loss of intraoperative neuromonitoring signals. Two patients had not undergone surgery at the last visit with a mean Cobb angle of 75.5 degrees. The mean postoperative follow-up for the surgical group (cases 1 to 3) was 3±3.6 years (range, 0.6 to 7.2 y) and the mean total follow-up for both groups was 6.6±2.5 years (range, 2.6 to 8.6 y).
  
  
  CONCLUSIONS
  Scoliosis in ACS can represent a clinically significant problem that is underdiagnosed and overshadowed by the other severe medical complications associated with the syndrome. Our data suggest that scoliosis in patients with ACS is rapidly progressive and bracing is ineffective; early screening, close observation, and low threshold for referral to an orthopedic surgeon are crucial.
  
  
  METHODS
  Level IV-case series.
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Grigoriou
authors.forename: Jessica Jo
authors.initials: JJ
authors.lastname: DeSabato
authors.forename: Dino
authors.initials: D
authors.lastname: Colo
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
mesh_terms: D058540:Aicardi Syndrome / Q000150:complications / Q000503:physiopathology; D001915:Braces / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013131:Spine / Q000601:surgery; D061665:Time-to-Treatment; D016896:Treatment Outcome