Developmental anomalies of the cervical spine in patients with fibrodysplasia ossificans progressiva are distinctly different from those in patients with klippel-feil syndrome : Clues from the BMP signaling pathway

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2005-06, Vol.30 (12), p.1379-1385
• Main Authors: SCHAFFER, Alyssa A, KAPLAN, Frederick S, TRACY, Michael R, O'BRIEN, Megan L, DORMANS, John P, SHORE, Eileen M, HARLAND, Richard M, KUSUMI, Kenro
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Animals; Biological and medical sciences; Bone Morphogenetic Proteins - antagonists & inhibitors; Bone Morphogenetic Proteins - genetics; Bone Morphogenetic Proteins - metabolism; Carrier Proteins - genetics; Cerebrospinal fluid. Meninges. Spinal cord; Cervical Vertebrae - abnormalities; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Injuries of the nervous system and the skull. Diseases due to physical agents; Klippel-Feil Syndrome - metabolism; Klippel-Feil Syndrome - pathology; Klippel-Feil Syndrome - physiopathology; Male; Medical sciences; Mice; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Muscle Rigidity - etiology; Muscle Rigidity - physiopathology; Myositis Ossificans - metabolism; Myositis Ossificans - pathology; Myositis Ossificans - physiopathology; Nervous system (semeiology, syndromes); Neurology; Range of Motion, Articular; Signal Transduction; Traumas. Diseases due to physical agents
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000166619.22832.2c

A radiographic analysis of the cervical spine of 70 patients diagnosed with fibrodysplasia ossificans progressiva (FOP) and 33 diagnosed with Klippel-Feil (KF) syndrome was conducted. The objectives of this study were to describe cervical spine abnormalities in patients with FOP, to compare and contrast those findings with the malformations in patients with KF syndrome, and to examine the possible etiology of these abnormalities. Congenital features of diseases often provide seminal clues to underlying etiology and developmental pathways. While progressive metamorphosis of connective tissue to heterotopic bone is the most dramatic and disabling feature of FOP, less severe congenital anomalies of the skeleton are also present. Vertebral fusions observed in KF are consistent with defects in embryonic segmentation. The cervical spine plain films of 70 FOP patients and 33 KF patients with documented congenital abnormalities were reviewed. Generalized neck stiffness and decreased range of motion were noted in most children with FOP. In the FOP patient group, characteristic anomalies, including large posterior elements, tall narrow vertebral bodies,and fusion of the facet joints between C2 and C7, were observed. Most notably, these characteristic anomalies of the cervical spine in patients with FOP were distinctly different from those of 33 patients with KF that were examined but were strikingly similar to those seen in mice with homozygous deletions of the gene-encoding noggin, a bone morphogenetic protein (BMP) antagonist. FOP patients exhibit a characteristic set of congenital spine malformations. While the noggin gene (NOG) is not mutated in patients who have FOP, these findings extend a growing body of evidence implicating overactivity of the BMP signaling pathway in the molecular pathogenesis of FOP.