Skip to main content
Log in

First description of frequent occurrence of supernumerary lumbar ribs and transitional vertebrae in children with Williams–Beuren syndrome

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Williams–Beuren syndrome is a rare multisystemic genetic disorder with an incidence of 1 in 7,500 live births. Because these children often have scoliosis, they undergo routine radiographic examinations of the spine. During these examinations we have found many children with supernumerary lumbar ribs arising from the first lumbar vertebra, often associated with lumbosacral transitional vertebrae.

Objective

To describe the incidence of supernumerary ribs and transitional vertebrae in children with Williams–Beuren syndrome and compare it to the incidence in a general population. Our hypothesis is that these findings are common, but they have not been described in the literature concerning Williams–Beuren syndrome.

Materials and methods

From January 2015 to October 2021, 308 patients (138 male) with Williams–Beuren syndrome were treated at our hospital. Of these, 106 (47 male) underwent diagnostic imaging, mostly for suspected scoliosis. Panoramic radiographs of the whole spine were performed in 88 patients and radiographs of regions of the spine, chest radiographs, CT, MRI or fluoroscopy in 18 patients. We retrospectively analysed the images concerning the number of ribs and vertebrae. We correlated the frequency of lumbar ribs and transitional vertebrae in comparison to a general population as described in the literature.

Results

After exclusions for insufficient imaging, we analysed imaging in 91 patients. Of these, 67 patients (73.6%) had 13 ribs, of which 85% were located on both sides, 9% on the right and 6% on the left side. Of the 67 patients with supernumerary lumbar ribs, 38 (57%) also had transitional vertebrae.

Conclusion

Supernumerary lumbar ribs arising from the first lumbar vertebra, often accompanied by lumbosacral transitional vertebrae, are common in children with Williams–Beuren syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Strømme P, Bjørnstad PG, Ramstad K (2002) Prevalence estimation of Williams syndrome. J Child Neurol 17:269–271

    Article  Google Scholar 

  2. Pober BR (2010) Williams-Beuren syndrome. N Engl J Med 362:239–252

    Article  CAS  Google Scholar 

  3. Collins RT II (2018) Cardiovascular disease in Williams syndrome. Curr Opin Pediatr 30:609–615

    Article  Google Scholar 

  4. Pankau R, Partsch CJ, Gosch A et al (1992) Statural growth in Williams-Beuren syndrome. Eur J Pediatr 151:751–755

    Article  CAS  Google Scholar 

  5. Pober BR, Morris CA (2007) Diagnosis and management of medical problems in adults with Williams-Beuren syndrome. Am J Med Genet C Semin Med Genet 145c:280–290

    Article  Google Scholar 

  6. Kaplan P, Kirschner M, Watters G, Costa MT (1989) Contractures in patients with Williams syndrome. Pediatrics 84:895–899

    Article  CAS  Google Scholar 

  7. Morris CA, Braddock SR, Council on Genetics (2020) Health care supervision for children with Williams syndrome. Pediatrics 145:e20193761

    Article  Google Scholar 

  8. Pankau R, Gosch A, Wessel A, Partsch CJ (2015) Das Williams-Beuren-syndrom [The Williams-Beuren syndome]. University Communications, Munich University of Applied Sciences

  9. Aly I, Chapman JR, Oskouian RJ et al (2016) Lumbar ribs: a comprehensive review. Childs Nerv Syst 32:781–785

    Article  Google Scholar 

  10. Davran R, Bayarogullari H, Atci N et al (2017) Congenital abnormalities of the ribs: evaluation with multidetector computed tomography. J Pak Med Assoc 67:178–186

    Google Scholar 

  11. Aignătoaei AM, Moldoveanu CE, Căruntu ID et al (2018) Incidental imaging findings of congenital rib abnormalities — a case series and review of developmental concepts. Folia Morphol 77:386–392

    Article  Google Scholar 

  12. Pionnier R, Depraz A (1956) [Congenital rib abnormalities; statistical study of 10,000 radiographs]. Radiol Clin 25:170–186

    CAS  Google Scholar 

  13. Steiner HA (1943) Roentgenologic manifestations and clinical symptoms of rib abnormalities. Radiology 40:175–178

    Article  Google Scholar 

  14. Adibatti M, Asha K (2015) Lumbarisation of the first sacral vertebra a rare form of lumbosacral transitional vertebra. Int J Morphol 33:48–50

    Article  Google Scholar 

  15. Garg B, Mehta N, Goyal A et al (2021) Variations in the number of thoracic and lumbar vertebrae in patients with adolescent idiopathic scoliosis: a retrospective, observational study. Int J Spine Surg 15:359–367

    Article  Google Scholar 

  16. Beuren AJ, Apitz J, Harmjanz D (1962) Supravalvular aortic stenosis in association with mental retardation and a certain facial appearance. Circulation 26:1235–1240

    Article  CAS  Google Scholar 

  17. Williams JC, Barratt-Boyes BG, Lowe JB (1961) Supravalvular aortic stenosis. Circulation 24:1311–1318

    Article  CAS  Google Scholar 

  18. Lightwood R (1932) A case of dwarfism and calcinosis: associated with widespread arterial degeneration. Arch Dis Child 7:193–208

    Article  CAS  Google Scholar 

  19. Fanconi G (1951) [Chronic disorders of calcium and phosphate metabolism in children]. Schweiz Med Wochenschr 81:908–913

    CAS  Google Scholar 

  20. Damasceno ML, Cristante AF, Marcon RM, Barros Filho TE (2014) Prevalence of scoliosis in Williams-Beuren syndrome patients treated at a regional reference center. Clinics 69:452–456

    Article  Google Scholar 

  21. Morris CA et al (1993) Williams syndrome. In: Adam MP, Ardinger HH, Pagon RA et al (eds) GeneReviews. University of Washington, Seattle

  22. Kruszka P, Porras AR, de Souza DH et al (2018) Williams-Beuren syndrome in diverse populations. Am J Med Genet A 176:1128–1136

    Article  Google Scholar 

  23. Game X, Panicker J, Fowler CJ (2010) Williams-Beuren syndrome. N Engl J Med 362:1449 (author reply 1450)

  24. Morris CA, Pani AM, Mervis CB et al (2010) Alpha 1 antitrypsin deficiency alleles are associated with joint dislocation and scoliosis in Williams syndrome. Am J Med Genet C Semin Med Genet 154c:299–306

    Article  CAS  Google Scholar 

  25. Spencer HT, Gold ME, Hresko MT (2014) Abnormal rib count in scoliosis surgery: impact on the reporting of spinal fusion levels. J Child Orthop 8:497–503

    Article  Google Scholar 

  26. Hu Z, Zhang Z, Zhao Z et al (2016) A neglected point in surgical treatment of adolescent idiopathic scoliosis: variations in the number of vertebrae. Medicine 95:e4682

    Article  Google Scholar 

  27. Struthers J (1874) Variations of the vertebrae and ribs in man. J Anat Physiol 9:17–96

    CAS  Google Scholar 

  28. Cumming J (1926) Lumbar rib of unrecorded type. Br Med J 1:55

    Article  CAS  Google Scholar 

  29. Bagnall KM, Harris PF, Jones PR (1984) A radiographic study of variations of the human fetal spine. Anat Rec 208:265–270

    Article  CAS  Google Scholar 

  30. Chernoff N, Rogers JM (2004) Supernumerary ribs in developmental toxicity bioassays and in human populations: incidence and biological significance. J Toxicol Environ Health B Crit Rev 7:437–449

    Article  CAS  Google Scholar 

  31. Taslimi MM, Glass BA (1990) Supernumerary ribs and vertebrae in trisomy 9 syndrome. Prenat Diagn 10:481

    Article  CAS  Google Scholar 

  32. Gedikbasi A, Yararbas K, Yildirim G et al (2009) Prenatal diagnosis of VACTERL syndrome and partial caudal regression syndrome: a previously unreported association. J Clin Ultrasound 37:464–466

    Article  Google Scholar 

  33. Hershkovitz R (2008) Prenatal diagnosis of isolated abnormal number of ribs. Ultrasound Obstet Gynecol 32:506–509

    Article  CAS  Google Scholar 

  34. Nakajima A, Usui A, Hosokai Y et al (2014) The prevalence of morphological changes in the thoracolumbar spine on whole-spine computed tomographic images. Insights Imaging 5:77–83

    Article  Google Scholar 

  35. Erken E, Ozer HT, Gulek B, Durgun B (2002) The association between cervical rib and sacralization. Spine 27:1659–1664

    Article  Google Scholar 

  36. Lian J, Levine N, Cho W (2018) A review of lumbosacral transitional vertebrae and associated vertebral numeration. Eur Spine J 27:995–1004

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annette Schmitz.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schmitz, A., Reutershahn, E., Seiffert, P. et al. First description of frequent occurrence of supernumerary lumbar ribs and transitional vertebrae in children with Williams–Beuren syndrome. Pediatr Radiol 53, 244–248 (2023). https://doi.org/10.1007/s00247-022-05493-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-022-05493-6

Keywords

Navigation