Xueyuan Wu1, Ming Ling2, Yanhai Chang1, Zhengming Sun1. 1. Department of Orthopaedics, Shaanxi Provincial People's Hospital, You Yi Western Road No. 256, Xi'an, 710068, Shaanxi, China. 2. Department of Orthopaedics, Shaanxi Provincial People's Hospital, You Yi Western Road No. 256, Xi'an, 710068, Shaanxi, China. lingming0114@163.com.
Abstract
PURPOSE: KBD is an endemic disease affecting the epiphyseal growth plate and articular cartilage of multiple joints, resulting in extremities' deformation and skeletal dysplasia. More attention has been paid to the visible deformed extremities instead of inconspicuous spinal condition. There is a lack of reports concerning the spinal radiological features, especially for the atlantoaxial joint. The aim of this paper is to report a case of a Kashin-Beck disease (KBD) patient diagnosed with atlantoaxial subluxation, concomitant with separated odontoid process fused to the enlarged anterior arch of the atlas. METHODS: We report the case of a 60-year-old woman with 54 years' history of KBD complaining of occipitocervical pain, decreasing motor strength and sensory function of both upper and lower extremities. Subsequent radiological examinations of lateral plain radiography, computed tomography scans and magnetic resonance imaging were performed to reveal these rare characteristics of atlantoaxial joint in this patient. Then, we review the associated articles to postulate whether this anomaly is accidental or linked in a KBD patient. RESULTS: She had an extremely rare variant with three aspects of characteristics: atlantoaxial subluxation concurrent with severe spinal canal stenosis and spinal cord compression, odontoid process separating from the body of axis, and the enlarged anterior arch of the atlas fusion with odontoid process. Comparing with the congenital anomaly of atlantoaxial joint, we postulated that this aetiology of anomaly might be linked to the acquired form attributed to the histopathology of KBD, rather than an accidental event. CONCLUSIONS: The anomaly of atlantoaxial joint might occur in KBD patients. Larger numbers of KBD candidates with earlier symptoms are recommended for radiological examinations of atlantoaxial joint, especially for the adolescents. Spinal surgeons are suggested to involve the research of the spinal anatomy and variation for the prevention and earlier therapy for KBD patients.
PURPOSE: KBD is an endemic disease affecting the epiphyseal growth plate and articular cartilage of multiple joints, resulting in extremities' deformation and skeletal dysplasia. More attention has been paid to the visible deformed extremities instead of inconspicuous spinal condition. There is a lack of reports concerning the spinal radiological features, especially for the atlantoaxial joint. The aim of this paper is to report a case of a Kashin-Beck disease (KBD) patient diagnosed with atlantoaxial subluxation, concomitant with separated odontoid process fused to the enlarged anterior arch of the atlas. METHODS: We report the case of a 60-year-old woman with 54 years' history of KBD complaining of occipitocervical pain, decreasing motor strength and sensory function of both upper and lower extremities. Subsequent radiological examinations of lateral plain radiography, computed tomography scans and magnetic resonance imaging were performed to reveal these rare characteristics of atlantoaxial joint in this patient. Then, we review the associated articles to postulate whether this anomaly is accidental or linked in a KBD patient. RESULTS: She had an extremely rare variant with three aspects of characteristics: atlantoaxial subluxation concurrent with severe spinal canal stenosis and spinal cord compression, odontoid process separating from the body of axis, and the enlarged anterior arch of the atlas fusion with odontoid process. Comparing with the congenital anomaly of atlantoaxial joint, we postulated that this aetiology of anomaly might be linked to the acquired form attributed to the histopathology of KBD, rather than an accidental event. CONCLUSIONS: The anomaly of atlantoaxial joint might occur in KBD patients. Larger numbers of KBD candidates with earlier symptoms are recommended for radiological examinations of atlantoaxial joint, especially for the adolescents. Spinal surgeons are suggested to involve the research of the spinal anatomy and variation for the prevention and earlier therapy for KBD patients.
Entities:
Keywords:
Atlantoaxial subluxation; Fusion; Kashin–Beck disease; Odontoid process
Authors: Q Fu; J Cao; J B Renner; J M Jordan; B Caterson; V Duance; M Luo; V B Kraus Journal: Osteoarthritis Cartilage Date: 2015-01-24 Impact factor: 6.576