The cervical spine in hemophilia

Area of Science:

• Orthopedics
• Hematology
• Radiology

Background:

• Hemophilia A and B are inherited bleeding disorders.
• Cervical spine involvement in hemophilia is not well-documented.
• Patients with hemophilia may be at risk for spinal complications.

Purpose of the Study:

• To determine the incidence of cervical spine involvement in patients with hemophilia A or B.
• To identify clinical and radiographic abnormalities of the cervical spine in this population.
• To discuss the implications of occult cervical spine instability.

Main Methods:

• Retrospective review of 53 hemophilia patients.
• Prospective examination of 25 hemophilia patients, including history, physical, and cervical spine X-rays (AP, lateral flexion-extension).
• Radiographic assessment by a board-certified radiologist.

Main Results:

• 8 of 25 prospective patients reported neck discomfort; 9 had restricted range of motion.
• Radiographic abnormalities were found in 13 of 25 patients.
• Ten patients showed vertebral body changes; two had an increased atlanto-dens interval.

Conclusions:

• Cervical spine abnormalities, including occult instability, are prevalent in hemophilia patients.
• Clinical symptoms and radiographic findings suggest a need for vigilance.
• Further investigation into the ramifications of cervical spine involvement is warranted.