Post on 10-Oct-2020
EDNF 2012 Conference August 2012
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A. Atiq Durrani, MD Center For Advanced Spine Technologies
Cincinnati, OH
Cervical Spine Issues in EDS
� C1-‐C2 instability � Cranio-‐cervical Instability. � Lower Cervical kyphosis. � Cervical disc degeneration ( Most common at C4-‐5, C5-‐6).
� Chiari Malformation
SYMPTOMS
EDNF 2012 Conference August 2012
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Diagnosing C1-‐C2 Instability
Common Symptoms of Cervical Instability
× Occipital headaches × Neck pain × Passing out at the extremes of lateral rotation × Choking sensations × Base of skull tenderness × Jaw pain
NECK PAIN
EDNF 2012 Conference August 2012
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Symptoms
Symptoms
Symptoms
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Symptoms
Symptoms
Dx Tests
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MRI with Flexion and Extension � What we look for:
� Cleido-‐clivus angle � Grubbs Oak distance � Distance between clivus and dens � Cranial settling/Chiari malformation � Subluxation of vertebrae
Measurements
EDNF 2012 Conference August 2012
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SubluxaFon of C2 on C3
Cranial SeIling or Chiari MalformaFon
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3D CT Neutral
3D CT LeL
3D CT Right
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% uncovering of facets � Blue line measures the C2 facet. � Green line measures the amount of C1 facet that covers C2.
� With these numbers, % uncovered can be calculated.
Treatment
Asymptomatic-‐ Observation
Treatment � Symptomatic
� Physical Therapy-‐ � Cranio-‐Sacral Alignment. � Cervical Collar.
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Treatment
� Interventional Pain Procedures. � Occipital nerve Blocks � Cervical Epidural / Foraminal Injections.
Treatment
� If Conservative means fail to control symptoms , then Cervical Spinal Fusion is the preferred Surgical Treatment.
SymptomaFc C1-‐C2 instability in EDS paFents can be surgically treated with a C1-‐C2 fusion
EDNF 2012 Conference August 2012
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KH Pre-‐Op
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KH 1 yr Post-‐Op
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JM Pre-‐Op
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JM 1 yr Post-‐Op
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Outcomes
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Outcomes
� Between 1/2009 and 8/2011, N= 25. � 1 year follow up. � All patients underwent stabilization for C1-‐C2.
Outcomes. � Mean Pre-‐op Pain – 8 � Mean post op pain at one year-‐ 2 � One patient still had residual pain. � Screw fracture in one patient. � Headaches resolved in 92% of patients. � Will you do this procedure again – 95%.
Conclusion � Cervical Spinal Instability is a common reason for EDS patients suffering from headaches and Cranio-‐Cervical pain.
� It is under-‐ appreciated by the spine community and not very well understood.
� In many circumstances, patients complaining of such complaints go through extensive work up with no treatment offered in the end.
� Stabilization of O-‐C1-‐C2, complex resolves cranio-‐cervical symptoms in EDS patients.
EDNF 2012 Conference August 2012
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Pain at Best
Pain at Worst
Pain on Average
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NEWMAN
NEWMAN
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Classical type (formerly Types I and II) EDS Signs and symptoms include: � Loose joints � Highly elastic, velvety skin � Fragile skin that bruises or tears easily � Redundant skin folds, such as on the eyelids � Slow and poor wound healing leading to wide scarring � Noncancerous fibrous growths on pressure areas, such as elbows and
knees; fatty growths on the shins and forearms � Muscle fatigue and pain � Heart valve problems (mitral valve prolapse and aortic root dilation)
Hypermobility type (formerly type III) EDS � Signs and symptoms include: � Loose, unstable joints with many dislocations � Easy bruising � Muscle fatigue and pain � Chronic degenerative joint disease � Advanced premature osteoarthritis with chronic pain � Heart valve problems (mitral valve prolapse and aortic root dilation)
EDNF 2012 Conference August 2012
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Vascular type (formerly type IV) EDS � This type of EDS is rare, but it's one of the most serious. It affects an estimated 1 in 100,000 to 200,000 people. Signs and symptoms include:
� Fragile blood vessels and organs that are prone to tearing (rupture)
� Thin, translucent skin that bruises easily � Characteristic facial appearance, including protruding eyes, thin nose and lips, sunken cheeks and small chin
� Collapsed lung (pneumothorax) � Heart valve problems (mitral valve prolapse and others)
ComplicaFons � Depend on your symptoms and type of EDS, but some common ones include:
� Prominent scarring � Difficulty with surgical wounds — stitches may tear out, or healing may be incomplete
� Chronic joint pain � Joint dislocation � Early onset arthritis � Premature aging with sun exposure
ComplicaFons with Vascular EDS � Serious complications can arise with vascular EDS such as � Tearing (rupture) of major blood vessels,
� i.e., ruptured or dissected artery or an aneurysm, � rupture of organs, such as the intestines or uterus.
� These complications can be fatal. About 1 in 4 people with vascular type EDS develop a significant health problem by age 20, and more than 80 percent develop complications by age 40. The median age of death is 48 years.