Head Posture and Upper Spine Morphological Deviations in Patients With Hypermobile Ehlers–Danlos Syndrome

Objective: To compare head posture and upper spine morphology in hypermobile Ehlers-Danlos syndrome (hEDS) patients with healthy controls with neutral occlusion. Materials and Methods: The study consisted of 27 hEDS patients (23 females, 4 males, mean age 36.41 ± 11.35) and 39 healthy controls (28 females, 11 males, mean age 31.85 ± 11.35) with neutral occlusion and no previous orthodontic treatment. Head posture was analysed by angular measurements on lateral cephalograms taken in natural head position and upper spine morphology was assessed on Cone Beam Computed Tomography (CBCT) by visual analysis of fusion and partial cleft of the upper spine and compared by general linear and logistic analyses adjusted for age and gender. Results: In total, upper spine morphological deviations occurred significantly more often in hEDS patients (51.9%) compared to controls (15.4%) (p = 0.007). Out of the two categories of upper spine morphological deviations (fusion anomalies and posterior arch deficiencies (PAD)), PAD occurred significantly more often in hEDS patients (48.1%) compared to controls (12.8%) (p = 0.007). The differences remained significant when p-values were corrected for multiple testing comparing groups. Head posture was almost significantly more extended in hEDS patients compared to controls when the p-values were corrected for multiple testing comparing groups (NSL/VER, p = 0.089; NSL/OPT, p = 0.080). Conclusions: The results of the present study indicate that upper spine morphology is affected in hEDS patients. The results may contribute to a further understanding of the spinal phenotypic spectrum in hEDS patients and thus prove valuable in the diagnostics and treatment of hEDS patients.