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Prevalence and radiographic features of atlantoaxial dislocation in adult patients with Kashin–Beck disease

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Abstract

Purpose

Kashin–Beck disease (KBD) is an endemic osteoarthropathy affecting the epiphyseal growth plate of multiple joints in young and adolescent patients. Previous studies have focused on the visible deformed extremities instead of the spinal radiological features, especially the atlantoaxial joint. The aim of this study was to determine the prevalence and radiographic features of atlantoaxial dislocation (AAD) in adult patients with KBD.

Methods

This study was conducted on KBD patients in three typical endemic counties between October 2017 and November 2019. The patients were evaluated by collecting basic information, clinical signs and symptoms. They underwent dynamic cervical radiography, by which AAD was diagnosed. For those patients with confirmed or suspected AAD, computed tomography (CT) imaging was performed to observe the odontoid morphology and degenerative changes in the lateral atlantoaxial joints. Radiographic evaluations were reviewed to determine the prevalence and features of AAD.

Results

A total of 39 (14.6%) of 267 KBD patients were diagnosed with AAD. Compared with the non-AAD patients, the detection rate of AAD was associated with a longer disease duration and stage and was not associated with age, sex or BMI. Thirty-two patients had symptoms at the neck or neurological manifestations, while seven had no symptoms. There were three types of morphologies of the odontoid process in AAD patients: separating in 19 cases, hypoplastic in 15 cases and intact in five cases. Anterior dislocation was noted in 29 cases, and posterior dislocation was noted in ten cases. Thirty-four cases were reducible, and five were irreducible. The lateral atlantoaxial joints had different severities of degenerative changes in 17 cases.

Conclusions

This study revealed that the prevalence of AAD was 14.6% in adult KBD patients. The radiographic features of AAD include manifestations of odontoid dysplasia and chronic degenerative changes in atlantoaxial joints. KBD patients with severe stages and longer disease duration were more vulnerable to the occurrence of AAD. We postulate that this atlantoaxial anomaly might originate from chondronecrosis of the epiphyseal growth plate of the odontoid process in young and adolescent individuals. This study may provide a clinical reference to help clinicians screen, prevent and treat AAD in adult patients with KBD.

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Funding

Supported by the Natural Science Basic Research Program of Shaanxi Province (2019JM-517), the Science and Technology Development Fund of Shaanxi Provincial People’s Hospital (2019YXQ-10) and the Key Research and Development projection of Shaanxi Province (2018ZDXM-SF-054).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shaanxi Provincial People’s Hospital, No. 256 You Yi Western Road, Xi’an, 710068, Shaanxi Province, China

    Xueyuan Wu, Ming Ling, Zhankui Jin, Zhengming Sun, Yanhai Chang, Shizhang Liu, Zhi Yi & Zhehui Zhu

  2. Department of Gynaecology Surgery, Shaanxi Provincial People’s Hospital, No. 256 You Yi Western Road, Xi’an, 710068, Shaanxi Province, China

    Cuipei Hao

Authors
  1. Xueyuan Wu
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  2. Cuipei Hao
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  3. Ming Ling
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  4. Zhankui Jin
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  5. Zhengming Sun
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  6. Yanhai Chang
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  7. Shizhang Liu
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  9. Zhehui Zhu
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Contributions

Ming Ling and Zhankui Jin designed the study. Yanhai Chang and Shizhang Liu screened the patients and diagnosed with KBD. Cuipei Hao and Zhi Yi reviewed and collected the patients’ medical data. Zhengming Sun and Zhehui Zhu searched relevant literature. Xueyuan Wu analyzed the data collected and wrote the manuscript. Ming Ling and Zhankui Jin approved the final version of the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Ming Ling.

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Ethical approval

The study was approved by the Human and Ethics Committee for Medical Research of Shaanxi Provincial People’s Hospital. No organization sponsored the research.

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Informed consent was obtained from all the participants.

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The authors declare no competing interests.

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Wu, X., Hao, C., Ling, M. et al. Prevalence and radiographic features of atlantoaxial dislocation in adult patients with Kashin–Beck disease. International Orthopaedics (SICOT) 47, 781–791 (2023). https://doi.org/10.1007/s00264-022-05616-6

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