Background Familial dysautonomia (Riley-Day syndrome) is an autosomal reces
sive disorder primarily affecting individuals of Ashkenazi Jewish extractio
n. It affects the autonomic, central, and peripheral nervous systems. Spina
l deformity (mainly scoliosis) is the most common orthopaedic problem in pa
tients,vith familial dysautonomia. The objectives of our study were to docu
ment the prevalence of spinal deformity in a referral center for familial d
ysautonomia and to determine the effectiveness of bracing.
Methods: We performed a retrospective radiographic and clinical study of 12
3 patients with familial dysautonomia who had survived to the age of twenty
years or older.
Results: One hundred and two (83 percent) of the 123 patients had spinal de
formity: sixty-nine (56 percent) had scoliosis only thirty-one (25 percent)
had scoliosis as well as kyphosis, and two (2 percent) had kyphosis only,
Scoliosis was diagnosed by the age of ten years in sixty-four (52 percent)
of the patients. Of the sixty-five patients who were treated with bracing,
fifty-eight (89 percent) had progression and twenty-four (37 percent) under
went spinal arthrodesis. No risk factors for the presence or progression of
the curves could be found,
Conclusions: The prevalence of spinal deformity in patients with familial d
ysautonomia who had lived for at least twenty years was found to be 83 perc
ent. By the age of ten years, 52 percent of the patients had scoliosis and
21 percent had kyphosis with or without scoliosis, Bracing was found to be
of limited effectiveness as a definitive treatment for spinal deformity. Th
e curve progressed despite bracing in fifty-eight (89 percent) of sixty-fiv
e patients.