| 제목 |
Isolated Congenital Vertebral Anomalies in Torticollis Patients: Case Series |
| 소속 |
Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Department of Rehabilitation Medicine1 |
| 저자 |
Dae-Hyun Jang1*†, Da-Ye Kim1, Dong-Woo Lee1, Jung-Ro Yoon 1 |
Introduction
Because congenital muscular torticollis is the most common cause of abnormal posture of head and neck, other causes of the torticollis can be missed at the first diagnosis. Especially, vertebral anomalies are difficult to identify on physical examination or plain radiographs. Furthermore, they are likely to be overlooked, if they are not accompanying with other congenital defects such as VATER syndrome. However, there is a lack of reports about patients with isolated vertebral anomaly who have abnormal head and neck posture. Thus, we report case series of torticollis patients diagnosed with isolated vertebral anomalies.
Case reports
A total of 903 patients have been referred to rehabilitation department of our hospital due to abnormal head and neck posture from 2011 to 2017. Among them, eleven patients had vertebral or rib anomaly. All patients had no other defects other than bony anomaly and nine patients were diagnosed with bony anomaly before one-year old. All patients had plain x-rays taken, but only four images were confirmed as vertebral anomaly by radiologist.
Six patients (54.5%) had the isolated vertebral fusion and one patient showed the isolated butterfly vertebra. Three patients (27.2%) showed multiple vertebral anomalies which are accompanied with fusion, hemi vertebra and/or butterfly vertebra. One patient had the fusion of rib only, not vertebra. Seven of 11 patients (63.6%) showed only one level bony anomaly (Table 1 and Fig. 1).
Discussion
According to our cases, it is not easy to rule out vertebral anomalies (especially, in case of the isolated and only one level involvement) by physical examinations and x-ray findings when evaluating abnormal head and neck posture. Therefore, if there is no abnormality in the ultrasonography of the neck, or no improvement even if the physical therapy is continued, the vertebral anomalies should be evaluated.
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Table 1. Characteristics and radiologic findings of patients.
Figure 1. Cervical spine AP, lateral x-ray and 3-dimensional computed tomography
Figure 1. Cervical spine AP, lateral x-ray and 3-dimensional computed tomography
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