Abstract
Introduction Patients with spondylocostal dysostosis (SCD) have congenital spine and rib deformities associated with frequently severe thoracic insufficiency and respiratory compromise. The literature is largely composed of case reports and small cohorts, and there is little information regarding adults with this condition. In this report, we describe the natural history of a conservatively treated patient and include quality-of-life issues such as childbearing, athletic participation, and occupational selection. Case Presentation We present a patient with SCD who was conservatively treated by a single physician from birth for 31 years. Our patient was capable of a reasonably good quality of life through adulthood, including participation in gymnastics and employment. At age 18, she became pregnant and subsequently terminated the pregnancy due to obstetrical concerns for compromised respiration. She has had intermittent respiratory complaints and occasionally experiences dyspnea with exertion, but this only has limited her during certain activities in the past three years. Currently, she takes naproxen for chronic back pain with periodic exacerbations. Discussion Other cases in the literature have described adult SCD patients who have received nonoperative treatment and achieved a wide range of functional outcomes. This provides some limited evidence to suggest that select patients with SCD may be treated conservatively and achieve a reasonable quality of life. However, close clinical follow-up with these patients is recommended, particularly early on, considering the high rates of infant morbidity and mortality. Chest physiotherapy and early pulmonary care have been associated with favorable outcomes in infancy. Surgery to increase thoracic volume and correct scoliosis has been shown in some cases to improve respiratory function. Treatment depends on the degree of thoracic insufficiency and quality of life. The natural history of SCD remains largely unknown, but some patients are capable of relatively favorable life spans, employment, and participation in athletics.
Highlights
Patients with spondylocostal dysostosis (SCD) have congenital spine and rib deformities associated with frequently severe thoracic insufficiency and respiratory compromise. e literature is largely composed of case reports and small cohorts, and there is little information regarding adults with this condition
In 1938, Jarcho and Levin described two siblings who were noted to have short necks and trunks due to vertebral segmentation defects and rib anomalies [1]. roughout most of the 20th century, the term Jarcho-Levin syndrome (JLS) was used to describe two disorders affecting the axial skeleton which are recognized as distinct entities [2], spondylocostal dysostosis (SCD) and spondylothoracic dysplasia (STD)
Spondylocostal dysostosis has been associated with significant infant mortality and poor outcomes resulting from thoracic insufficiency and subsequent respiratory complications [5]
Summary
In 1938, Jarcho and Levin described two siblings who were noted to have short necks and trunks due to vertebral segmentation defects and rib anomalies [1]. roughout most of the 20th century, the term Jarcho-Levin syndrome (JLS) was used to describe two disorders affecting the axial skeleton which are recognized as distinct entities [2], spondylocostal dysostosis (SCD) and spondylothoracic dysplasia (STD). Roughout most of the 20th century, the term Jarcho-Levin syndrome (JLS) was used to describe two disorders affecting the axial skeleton which are recognized as distinct entities [2], spondylocostal dysostosis (SCD) and spondylothoracic dysplasia (STD). Both disorders have associated rib malformations and vertebral segmentation defects resulting in some degree of kyphoscoliosis, with each disorder having its own distinguishable radiographic appearance. We describe the relatively favorable 31-year clinical history of a patient with spondylocostal dyostosis, Klippel–Feil anomaly (KFA), and type II sacral agenesis. We describe the relatively favorable 31-year clinical history of a patient with spondylocostal dyostosis, Klippel–Feil anomaly (KFA), and type II sacral agenesis. e patient was seen in the newborn nursery, followed, and treated continuously by a single orthopaedic surgeon
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