RASopathies and spinal deformities for screening of scoliosis

Background: The RASopathies (Noonan syndrome [ NS] and Costello syndrome [CS]) are rare disorders. Although these have been characterized, precise delineation of the differences in the spinal deformities associated with RASopathy has not been described. This study characterized the spinal deformities found in NS and CS and describes a strategy for the screening of scoliosis. Methods: The clinical records and spinal X-rays of 35 consecutive NS and CS patients were reviewed. Spinal X-rays were assessed to define the presence and progression of scoliosis. Clinical records were examined to identify the risk factors associated with scoliosis. In addition, we investigated the association between clinical records and scoliosis using logistic regression analysis. Results: Twenty-four patients with NS and 11 with CS were included. Nine patients with NS and five with CS showed scoliosis. The mean +/- SD age at diagnosis was 12.6 +/- 2.4 years in NS and 11.4 +/- 2.5 years in CS ( p = 0.55), and mean follow-up period was 4.8 +/- 2.6 years and 6.3 +/- 2.4 years ( p = 0.42), respectively. The coronal angular deformity at final follow-up was 27.3 +/- 8.5 degrees in NS and 19.4 +/- 6.9 degrees in CS (p = 0.030) with a mean annual progression of 2.8 +/- 1.1 degrees in NS 1.0 +/- 1.0 degrees in CS (p = 0.030). Cardiac disease was present in eight out of nine patients with NS with concomitant scoliosis in NS, and significantly more than in CS (p = 0.007). PTPN11 significantly correlated with scoliosis (odds ratio 12.4 0.035, 95% confidence interval: 1.20-128.00). Conclusions: Spinal deformity in NS is more severe than in CS. This study identified a relationship between PTPN11 and scoliosis. Therefore, PTPN11 can be used for the screening of scoliosis.