Medical Student Tulane University New Orleans, Louisiana
Background and/or Objectives: Few studies have investigated the prevalence of decreased clivo-axial angles (CXA’s) in hypermobile-type Ehlers-Danlos Syndrome patients (hEDS). Cervical instability has been reported in these patients, however, the frequency of decreased CXA’s, and what degree these patients possess, has not been established. The clivo-axial angle exists between the clivus of the skull and the axis vertebrae, and when decreased, results in brainstem compression. This study will investigate the clivo-axial angles in patients who meet the criteria for hEDS.
Design: We conducted a retrospective chart review of 53 female and 4 male hEDS patients seen at the Tulane Hypermobility and EDS clinic between January 1, 2021 and June 1, 2022. Each patient met the 2017 diagnostic criteria for hEDS and was subsequently diagnosed. Patient charts were utilized to determine which patients underwent magnetic resonance imaging (MRI) of the cervical spine for suspected cervical instability. Angles were determined in neutral, flexion, and extension positions.
Setting: Tulane Hypermobility and EDS Clinic.
Participants: 53 female and 4 male patients with hEDS.
Interventions: not applicable.
Main Outcome Measures: Clivo-Axial angles determined on MRI.
Results: Normal CXA’s are approximately 155 degrees in neutral, 145 in flexion, and 165 in extension. The patients had an average neutral angle of 141 degrees (range 119-162), flexion angle of 133 (range 115-152), and extension angle of 160 (131-179) as independently reviewed on MRI. The average delta N-F was 8° and E-N was 18.67°.
Conclusions: This study establishes a correlation of decreased CXA’s in hEDS patients. This study also showed wider extension deltas between the angles in these patients. Further research needs to be conducted to determine if a more acute angle in flexion or neutral positioning correlates to a more severe degree of clinical symptoms.