Danlos syndrome a systematic review Nandan Marathe MS Spine Fellow Toronto Western Hospital Laura Nanna Lohkamp MD MSc Spine Fellow Toronto Western Hospital Prof Michael Fehlings ID: 931610
Download Presentation The PPT/PDF document "Diagnostic and treatment criteria of cr..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Diagnostic and treatment criteria of craniocervical instability in Ehlers Danlos syndrome – a systematic review
Nandan Marathe, MS, Spine Fellow, Toronto Western HospitalLaura-Nanna Lohkamp MD, MSc, Spine Fellow, Toronto Western HospitalProf. Michael Fehlings, Staff Neurosurgeon and Co-chair of the spine program, University of Toronto
Slide2Presenter- Nandan Marathe
Slide3Classification: Ehlers Danlos Syndrome
The Ehlers–Danlos syndromes (EDS) are a mixed group of connective tissue disorders characterized by overly moveable joints, stretchy skin, hyperlaxity.Incidence: 1/5000
5 subtypes related to spinal manifestations
Slide4IntroductionTreatment indications for craniocervical instability (CCI) in patients with EDS remain a matter of debate resulting in inconsistent surgical care availability among various
surgeons. Aim of this systematic review: summarize the diagnostic and therapeutic criteria currently applied in EDS and to identify consecutive knowledge gaps.
Slide5MethodsA systematic literature review using the databases Ovid Medline, EMbase
, Cochrane Library and PubMed based on the PRISMA guidelines. Search terms: Ehlers Danlos and spine, cervical spine, craniocervical instability or craniocervical junction.Articles were included if they described application of diagnostic and/or treatment criteria for CCI in the context of EDS.
Slide6Literature review for CCI
Low quantitative scientific
evidence !
Slide7Results
Diagnostic methods: Lateral flexion and extension x-rays of the cervical spineDynamic CT imagingParameters of craniocervical instability:Atlantodental interval (ADI)
Basion-axis interval (BAI) Clivo-axial angle (CXA)
Angular displacement of C1 to C2
The choice of diagnostic parameters was inconsistent
among
majority of
the articles
.
Treatment criteria:
Consistent in 2 studies: 42 EDS patients
Insufficient data in order to draw conclusions
Slide8Parameters of Cranio-cervical instability
Clivoaxial angle (CXA)Atlantodental interval (ADI)Basionaxis interval (BAI)Basiondens interval (BDI)
Slide9Case Example
normal
pathologic
Slide10ConclusionsT
here is a significant lack of evidence for the choice and correct application of CCI criteria in EDS patients. Parameters used (ADI, BAI, CXA and angular displacement between C1 and C2) warrant further assessment in bigger cohorts. Outcome data after craniocervical instrumentation: scarce and univocal, not able to guide surgical
decision-making. Knowledge gap: Further studies are required to evaluate a set of dedicated diagnostic criteria and to establish clinical guidelines for craniocervical instrumentation.