Orthopaedic manifestations of familial dysautonomia - A review of one hundred and thirty-six patients

Background Familial dysautonomia is a hereditary multisystemic disease prim arily affecting people of Ashkenazi Jewish descent. Musculoskeletal problem s are related to gait disorders, spinal deformities, foot deformities, frac tures, and arthropathies. Methods: The charts and radiographs of 136 patients who ranged in age from three months to forty-six years (mean, sixteen years) were reviewed. Sixty- four patients were available for follow-up examination. Results: Spinal deformity was the most common orthopaedic problem and was d iagnosed in seventy-eight patients starting at the age of four years, with a prevalence of 86 percent (forty-eight of fifty-six) by the age of fifteen Sears. Forty-one (53 percent) of the seventy-eight patients had scoliosis only, thirty-four (44 percent) had kyphoscoliosis, and three (4 percent) ha d kyphosis only. Bracing was accompanied by emotional, pulmonary, and skin problems, leading to a high rate of noncompliance and progression of the cu rve. Twenty-four patients had an operation at a mean age of thirteen years (rang e, five to eighteen years): twenty patients had posterior spinal arthrodesi s, acid four had combined anterior and posterior arthrodesis. Fifteen patie nts had a total of nineteen complications, of which seven were systemic and twelve were related to the spinal fixation. Eight patients had revision su rgery. At the time of the surgery, scoliosis was corrected from a mean of 5 5 degrees to a mean of 35 degrees and kyphosis was corrected from a mean of 69 degrees to a mean of 61 degrees. After a mean duration of follow-up of sixty-five months, scoliosis measured 49 degrees (range, 18 to 62 degrees) and kyphosis measured 67 degrees (ran ge, 30 to 115 degrees). Postoperative progression of the deformity was caus ed by failure of the instrumentation or progression in unfused segments. Wa lking was delayed in 72 percent (ninety-four) of the 130 patients who were of walking age. All sixty-four of the patients who,were examined had an ata xic gait. Foot deformities were found in sixteen patients, six of whom were treated surgically. Two patients had Charcot joints. Fifty-five patients s ustained at least one fracture before skeletal maturity, with a mean of 1.5 fractures per patient. All but one of the fractures,vas treated nonoperati vely, acid fracture-healing was often accompanied by profuse callus formati on. Conclusions Spinal deformity is common in patients,vith familial dysautonom ia, Bracing is of questionable benefit, and surgical intervention should be considered once curve progression is well documented. Arthrodesis should b e extended as far proximally as possible to prevent junctional kyphosis, Sw elling and warmth in a limb should raise suspicion of an undiagnosed fractu re.