The spine in diastrophic dysplasia

Diastrophic dysplasia is an autosomal recessive disorder of the skeleton, characterized by disproportionate short stature, generalized joint deformities, club feet, deformed ear pinnae, and, frequently, spinal deformity and cleft palate. Diastrophic dysplasia is more common in Finland than elsewhere. We studied 101 patients with an age range from newborns to 79 years to find out the frequency and type of spinal deformities, the early signs of progressive cases, and to follow the natural history of the disease. In the follow-up study, 17 patients were under 10 years, 21 under 21 years, and 63 over 21 years of age. One-third of the patients had cervical kyphosis; in the most severe case the kyphosis was 180 degrees and led to quadriplegia during anesthesia. In three patients, cervical kyphosis resolved spontaneously before the age of 5 years. The overall frequency of scoliosis was 37%; 49% in women and 22% in men. Only 13 patients had curves greater than 50 degrees; these curves constituted distinct rotation at the apex from the early evolution of the curve. The early signs of severe curves were detectable at the age of 2 to 4 years. Only two patients were operated on because of scoliosis; one with fusion in situ and the other instrumented with the pediatric Cotrel-Dubousset instrumentation. Three patients had a brace, which did not prevent the progression of the curve. Symptoms referring to a narrow spinal canal were registered in four patients, two of which were operated on; a lumbar posterior decompressive procedure was made at adult age.