Report of two cases and review of the literature

TLDR

Skeletal dysplasias are primarily bone disorders that are rarely viewed as neurosurgical diseases, yet they frequently cause neurosurgical complications and offer limited fusion options when bone quality is poor. The study reports two cervical spine instability cases from skeletal dysplasias and underscores that, currently, halo brace immobilization may be the sole viable treatment while future advances in chondrogenesis could improve fusion. One Gorham disease patient received prolonged halo brace fixation after failed posterior occiput‑C4 fusion, while the camptomelic dysplasia patient was managed conservatively from birth. Both cases confirm that fusion success is constrained by underlying bone quality, with inadequate bone formation or progressive loss preventing effective surgical stabilization.

Abstract

U Because skeletal dysplasias are primary disorders of bone, they have not been commonly understood as neurosurgical diseases. Nevertheless, neurosurgical complications are commonly encountered in many cases of dysplasia syndromes. The authors present two cases of skeletal dysplasia that caused overt instability of the cervical spine. One patient with a diagnosis of Gorham disease of the cervical spine was treated with prolonged fixation in a halo brace after an initial attempt at instrumentation with a posterior occiput‐C4 fusion. The other patient, who at birth was identified to have camptomelic dysplasia, has been treated conservatively from the outset. Although these two patients presented with different disorders—in one patient adequate mature bone never formed and in the other patient progressive bone loss became apparent after a seemingly normal initial development—these cases demonstrate unequivocally that surgical options for fusion are ultimately limited by the quality of the underlying bone. In patients in whom the bone itself is inadequate for use as a substrate for fusion, there are currently limited treatment options. Future improvements in our understanding of chondrogenesis and ossification may lead to the design of superior methods of encouraging fusion in these patients; however, at the present time, long-term maintenance in a halo brace may, in fact, be the only treatment.