Jarcho-Levin syndrome

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Jarcho-Levin Syndrome
Classification and external resources
Radiograph depicting typical skeletal features of Jarcho-Levin syndrome, subtype Spondylothoracic Dysplasia. Note fanlike configuration of the ribs, with extensive posterior fusion, along with multiple vertebral segmentation defects.
ICD-10 Q76.
ICD-9 756.9
OMIM #277300
DiseasesDB 32639

Jarcho-Levin Syndrome is a rare, heritable axial skeleton growth disorder. It is characterized by widespread and sometimes severe malformations of the vertebral column and ribs, shortened thorax, and moderate to severe scoliosis and kyphosis. Individuals with Jarcho-Levin typically appear to have a short trunk and neck, with arms appearing relatively long in comparison, and a slightly protuberant abdomen. Severely affected individuals may have life-threatening pulmonary complications due to deformities of the thorax. The syndrome was first described by Saul Jarcho and Paul M. Levin at Johns Hopkins University in 1938. [1]

While clinicians almost unanimously refer to the syndrome as "Jarcho-Levin", reports have variously labelled or referred to the condition as all of the following: Hereditary malformations of the vertebral bodies,[1] hereditary multiple hemivertebrae,[2] syndrome of bizarre vertebral anomalies,[3] spondylocostal dysplasia,[4] spondylothoracic dysplasia,[5] costovertebral anomalies,[6] costovertebral dysplasia,[7] spondylothoracic dysplasia,[8] occipito-facial-cervico-thoracic-abdomino-digital dysplasia[9] (deemed "ridiculously long" and "unwarranted" by OMIM)[1], and spondylocostal dysostosis.[10]

A closely related condition termed "Costovertebral segmentation defect with mesomelia and peculiar facies", or Covesdem syndrome, was first described in 1978 in India. [11]

Contents

[edit] Prognosis

Babies born with Jarcho-Levin may be very healthy and grow up to lead normal lives.[12] However, many individuals with Jarcho-Levin suffer from problems of respiratory insufficiency secondary to volume-restricted thoraces. These individuals will often develop pulmonary complications and die in infancy or early childhood.[1][2][13][14][15] The disparity in outcomes of those with the syndrome is related to the fact that Jarcho-Levin actually encompasses two or more distinct syndromes, each with its own range of prognoses. The syndromes currently recognized as subtypes of Jarcho-Levin are termed Spondylothoracic Dysplasia and Spondylocostal Dysostosis.

[edit] Subtypes and Characteristics

In 1968, Dr. David Rimoin and colleagues in Baltimore first distinguished between the two major presentations of Jarcho-Levin.[4] Both conditions were characterized as failures of proper vertebral segmentation. However, the condition within the family described in their article appeared to be inherited in a autosomal dominant fashion and had a less severe course than that reported by other investigators. They specified their condition as spondylocostal dysplasia, which has since become to be known as Spondylocostal Dysostosis. The subtype of Jarcho-Levin with which they contrasted their reported cases to is now known as Spondylothoracic Dysplasia.

[edit] Spondylothoracic Dysplasia

Characteristic radiograph from child with Jarcho-Levin syndrome, spondylothoracic dysplasia subtype
Characteristic radiograph from child with Jarcho-Levin syndrome, spondylothoracic dysplasia subtype


Spondylothoracic dysplasia, or STD, has been repeatedly described as an autosomal recessively inherited condition that results in a characteristic fan-like configuration of the ribs with minimal intrinsic rib anomalies. Infants born with this condition typically died early in life due to recurrent respiratory infections and pneumonia due to their restricted thorax.[3][5][16] Recently, a report[12] has documented that actual mortality associated with STD is only about 50%, with many survivors leading healthy, independent lives.







[edit] Spondylocostal Dysostosis

Characteristic radiograph from child with Jarcho-Levin syndrome, spondylocostal dysostosis subtype
Characteristic radiograph from child with Jarcho-Levin syndrome, spondylocostal dysostosis subtype


In contrast to STD, the subtype Spondylocostal dysostosis, or SCD features intrinsic rib anomalies, in addition to vertebral anomalies. Intrinsic rib anomalies include defects such as birfurcation, broadening and fusion that are not directly related to the vertebral anomalies (such as in STD, where extensive posterior rib fusion occurs due to segmentation defects and extreme shortening of the thoracic vertebral column).[12]

[edit] References

  1. ^ a b c Jarcho, S.; Levin, P.M. (1938). "Hereditary malformation of the vertebral bodies". Bull Johns Hopkins Hosp 62: 216-226. 
  2. ^ a b Van Der Sar, A. (1952). "Hereditary Multiple Hemivertebrae". Documenta de Medicina Geographica et Tropica. 
  3. ^ a b Lavy, N.W.; Palmer, C.G.; Merritt, A.D. (1966). "A syndrome of bizarre vertebral anomalies.". J Pediatr 69 (6): 1121-5. 
  4. ^ a b Rimoin, D.L.; Fletcher, B.D.; McKusick, V.A. (1968). "Spondylocostal dysplasia. A dominantly inherited form of short-trunked dwarfism.". Am J Med 45 (6): 948-53. 
  5. ^ a b Moseley, J.E.; Bonforte, R.J. (1969). "Spondylothoracic Dysplasia--a Syndrome Of Congenital Anomalies". American Journal of Roentgenology 106 (1): 166. 
  6. ^ Norum, R.A.; McKusick, V.A. (1969). "Costovertebral anomalies with apparent recessive inheritance". Birth Defects OAS 18: 326-329. 
  7. ^ Cantu, J.M.; Urrusti, J.; Rosales, G.; Roms, A. (1944). "Evidence for autosomal recessive inheritance of costovertebral dysplasia". Clinical Genetics 2: 149-154. 
  8. ^ Castroviejo, I.P.; Rodriguez-costa, T.; Castillo, F. (1973). "Spondylo-thoracic dysplasia in three sisters.". Dev Med Child Neurol 15 (3): 348-54. 
  9. ^ Perez-comas, A.; Garcia-castro, J.M. (1974). "Occipito-facial-cervico-thoracic-abdomino-digital dysplasia; Jarcho-Levin syndrome of vertebral anomalies. Report of six cases and review of the literature.". J Pediatr 85 (3): 388-91. 
  10. ^ Franceschini, P.; Grassi, E.; Fabris, C.; Bogetti, G.; Randaccio, M. (1974). "The autosomal recessive form of spondylocostal dysostosis.". Radiology 112 (3): 673-5. 
  11. ^ Wadia, R.S.; Shirole, D.B.; Dikshit, M.S. (1978). "Recessively inherited costovertebral segmentation defect with mesomelia and peculiar facies (Covesdem syndrome): A new genetic entity?". British Medical Journal 15 (2): 123. 
  12. ^ a b c Cornier, A.S.; Ramirez, N.; Arroyo, S.; Acevedo, J.; Garcia, L.; Carlo, S.; Korf, B. (2004). "Phenotype characterization and natural history of spondylothoracic dysplasia syndrome: A series of 27 new cases". American Journal of Medical Genetics 128 (2): 120-126. doi:10.1002/ajmg.a.30011. 
  13. ^ Poor, M.A.; Alberti, O.J.R.; Griscom, N.T.; Driscoll, S.G.; Holmes, L.B. (1983). "Nonskeletal malformations in one of three siblings with Jarcho-Levin syndrome of vertebral anomalies". The Journal of pediatrics 103 (2): 270-272. 
  14. ^ Karnes, P.S.; Day, D.; Berry, S.A.; Pierpont, M.E.M. (1991). "Jarcho-Levin syndrome: four new cases and classification of subtypes". American journal of medical genetics 40 (3): 264-270. 
  15. ^ Giacoia, G.P.; Say, B. (1991). "Spondylocostal dysplasia and neural tube defects". Journal of Medical Genetics 28 (1): 51. 
  16. ^ Pochaczevsky, R.; Ratner, H.; Perles, D.; Kassner, G.; Naysan, P. (1971). "Spondylothoracic dysplasia.". Radiology 98 (1): 53-8. 


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