The cervical spine in hemophilia.

Fifty-three patients with known hemophilia A or B were retrospectively reviewed to determine the incidence of cervical spine involvement. Twenty-five were examined prospectively, including a detailed history and physical examination and cervical spine roentgenograms consisting of an AP and lateral flexion-extension series. All roentgenograms were reviewed by a board-certified radiologist. The mean age of patients in both groups was 25.4 years (range, eight to 54 years). In the retrospective review, no patients were noted to have complaints referable to the cervical spine, although five patients had prior trauma to the cervical spine. In the prospective study, 8 of 25 patients complained of intermittent neck discomfort and 9 of 25 had restricted lateral rotation and/or lateral flexion. No patient had radicular symptoms or objective neurologic deficits. Roentgenograms showed abnormalities in 13 of 25 patients. Ten patients (aged 19 to 54 years; mean, 32 years) showed cystic changes or endplate irregularity within one or more vertebral bodies. Two patients, aged 15 to 19 years, had an increased atlanto-dens interval of 5 mm (normal, 3 mm). No odontoid erosion was noted. No correlation was found between the severity of peripheral involvement and the cervical spine roentgenograms. Occult instability of the cervical spine is discussed, along with ramifications for patients with hemophilia.