The Journal of Bone and Joint Surgery, Vol 75, Issue 5 656-662, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Congenital vertebral displacement
J Shapiro and J Herring
Texas Scottish Rite Hospital for Crippled Children, Dallas 75219-3993.
We defined congenital vertebral displacement as displacement at a single
vertebral level that results in an abrupt displacement of the neural canal.
We reviewed the data on 642 patients who had congenital vertebral
abnormalities and identified ten who had congenital vertebral displacement.
There were two patterns of deformity: Type A (eight patients) consisted of
displacement in the sagittal plane only, and Type B (two patients),
rotatory, transverse, and sagittal displacement. The spinal deformity was
usually noted in infancy. Neurological deficits were identified at the time
of presentation or developed later in six patients. Two patients had a
sudden onset of paraplegia after slight trauma, two had a gradual onset of
neurological abnormalities, and two had neurological abnormalities when
they were first seen. Three patients had congenital anomalies of the spinal
cord. We found marked mechanical instability intraoperatively in five
patients, and we believe that the instability in combination with
compression of the spinal cord resulted in myelopathy. We recommend
combined anterior and posterior arthrodesis of the spine for the treatment
of this disorder. We believe that decompression of the spinal cord is
indicated for patients who have a neurological deficit of recent onset or a
progressive neurological deficit. Decompression of the spinal cord may also
be indicated for the treatment of long-standing deficits after spinal
stability has been obtained.
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