Obesity and Hyperostosis of the Spinal Ligaments: A Comprehensive CT Analysis of the Entire Spine in a Random Trauma Population

Abstract

occurs in adults, it may predispose the KFS patient to a lower threshold for neurologic deficit. PURPOSE: To compare the clinical and the radiographical characteristics between KFS and the controls. STUDY DESIGN/SETTING: Retrospective 1:2 case: control study. PATIENT SAMPLE: 22 KFS and 44 control patients. OUTCOME MEASURES: Independent t-test. METHODS:We performed an independent 1: 2 case:control retrospective radiographic and chart review of a consecutive series of adult KFS patients (O18 years old) who underwent surgical intervention by a single surgeon between 1996-2007. The control group consisted of a consecutive group of non-KFS surgical patients operated by the same surgeon. Patients were matched in 1:2 case: control manner according to gender and BMI category (malnourished (!18.5); normal weight (18.5-25); overweight (25-30); obese (O30)). Their charts were reviewed and the clinical characteristics were compared. Axial T2-weighted MRI was used to measure the antero-posterior and medio-lateral axial spinal cord and spinal canal of the operative levels. Spinal cord and canal area were then calculated using the equation of an ellipse: Area (ellipse)5pi x (antero-posterior dimension) x (medio-lateral dimension), a previously validated technique. If there were multiple levels in a patient, the average area of the levels was used for comparison. RESULTS: A total of 22 KFS and 44 control patients were identified. The most common congenital fusion level was C2-3 followed by C3-4. 27% patients hadO1 congenital fusion level. In the KFS population, the surgical level was as follows: 1-level cephalad to the congenital fusion (17%), 1-level caudal to the congenital fusion (66%), in between 2 congenitally-fused areas (17%). The KFS group had a tendency of more myeloradiculopathy, and the control group had a tendency towards more radiculopathy. However, both tendencies were not significantly different. MRIs of 10 KFS and 22 control group were available. There was no difference in the area of both spinal cord and canal at the operative levels. CONCLUSIONS: Contrary to the finding in previous reports on pediatric patients, there were no differences between KFS and well-matched control group in terms of age of onset, presentation, revision rate, complication rates, surgical outcomes, and cross sectional spinal cord and canal dimensions at the operative level. This either suggests that previous reports may have erred or that KFS patients undergo a relative enlargement of the spinal cord as they grow. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.