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Syringomyelia in hereditary multiple exostosis
Janet M Legare1, Peggy Modaff2, Bermans J Iskandar3
1Division of Genetics and Metabolism, Department of Pediatrics, University of Wisconsin, Madison, Wisconsin. jmlegare@pediatrics.wisc.edu.
Insights
Hereditary Multiple Exostosis (HME) patients may have a higher incidence of syringomyelia, often linked to tethered cords. Spinal MRI is recommended for early detection in HME patients exhibiting neurological symptoms.
Area of Science:
- Medical Genetics
- Neurology
- Orthopedics
Background:
- Hereditary Multiple Exostosis (HME) is a genetic disorder characterized by multiple bone tumors (exostoses).
- Syringomyelia, a fluid-filled cyst within the spinal cord, can cause neurological deficits.
- The association between HME and syringomyelia, particularly without spinal osteochondromas, requires further investigation.
Purpose of the Study:
- To investigate the incidence and characteristics of syringomyelia in children with Hereditary Multiple Exostosis.
- To determine the relationship between syringomyelia, tethered cord, and spinal osteochondromas in HME patients.
- To assess the utility of spinal MRI in diagnosing neurological complications in HME.
Main Methods:
- Retrospective review of patients diagnosed with Hereditary Multiple Exostosis (HME) at a specialized clinic.
- Analysis of clinical data, neurological symptoms, and imaging findings (MRI) of the spine.
- Correlation of syringomyelia and tethered cord/fibrolipoma presence with HME diagnosis.
Main Results:
- Five children with HME were identified with co-existing syringomyelia; four also had a tethered cord/fibrolipoma.
- No spinal osteochondromas were found in these HME patients with syringomyelia.
- Approximately 13% of HME patients in the study cohort had syringomyelia, suggesting an increased incidence.
Conclusions:
- Syringomyelia appears to be more common in patients with Hereditary Multiple Exostosis, independent of spinal osteochondromas.
- Tethered cord/fibrolipoma may be associated with syringomyelia in the HME population.
- A low threshold for spinal MRI is warranted in HME patients presenting with neurological signs or symptoms.
Abstract:
We describe five children with Hereditary Multiple Exostosis (HME) who also had syringomyelia. Of these, four had a tethered cord/fibrolipoma. No spinal osteochondromas were found in these patients. All had antecedent neurological signs or symptoms that prompted spinal imaging with MRI. Of all patients with HME seen in the Midwest Regional Bone Dysplasia Clinic from 1982 to present, 44% (17/39) of patients had signs or symptoms concerning for possible cord-related neurological findings. However, only 10 of 39 had spinal imaging. Assuming that all individuals with syringomyelia were identified, then 5/39 (13%) were in that way affected. This, of course, is a minimal estimate given that many were not imaged. The incidence of syringomyelia appears to be increased in this population, and seems to be unrelated to spinal osteochondromas. A low threshold for obtaining spinal MRI in patients with Hereditary Multiple Exostosis seems rational. © 2016 Wiley Periodicals, Inc.
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