Melorheostosis and the sclerotomes: A radiological correlation

Abstract

Melorheostosis is characterised radiologically by hyperostotic linear densities in bone. These densities have a peculiarly segmental distribution which does not correspond with the anatomical course of blood vessels or mixed nerve roots of the limbs. So far this disbritubion has lacked any valid explanation, although it has been suggested to be a developmental error as a result of an embryonic metameric disturbance. Inman and Saunders in 1944 described a sensory nerve supply to skeletal structures with 'sclerotomes' representing the zones of the skeleton supplied by individual spinal sensory nerves. Radiographs of 30 cases from the Radiological Museum of the Institute of Orthopaedics, London, have been reviewed and an attempt has been made to correlate the sclerosing lesions with the sclerotomes. The investigation was handicapped by paucity of films and clinical information, but in 19 cases the skeletal abnormalities were considered to correspond with a single sclerotome or part thereof. These studies were convincing when films of an affected hand or foot were available. In the remaining 11 cases multiple sclerotomes appeared to be involved and the clinical manifestations were correspondingly more severe. It is proposed that melorheostosis may be the late result of a segmental sensory nerve lesion, to account for its sclerotomal distribution. The association with linear scleroderma is discussed, since it has been suggested that these cutaneous lesions are related to the same nerve segment. Eight cases showed paraarticular ossification of soft tissues which may be related to involvement of a corresponding myotome.

Symmetry of bone lesions in osteopoikilosis

“…A symmetric distribution of the lesions has been observed in osteopoikilosis (Murray and McCredie 1979), although this has not been statistically analyzed. The radiopaque areas can increase or decrease in size and number, or even disappear (Holly 1936).…”

“…Osteosclerotic foci were recorded according to sclerotomes (McCredie 1976, Murray andMcCredie 1979). The osteosclerotic foci in all the sclerotomes were distributed in complete symmetry (Figure 2).…”

Case Report: Severe Melorheostosis Involving the Ipsilateral Extremities

“…In 1979, Murray and McCredie [13] suggested an infection associated with nerve roots may be responsible for melorheostosis, because they detected a good correlation between hyperostotic lesions and the sclerotomes. This may in part explain the monomelic and linear track involvement and distribution of melorheostosis.…”

Localised melorheostosis

“…Surgical procedures consist of soft-tissue procedures such as tendon lengthening, excision of fibrous and osseous tissue, fasciotomy, capsulotomy, osteotomies and excision of hyperostoses, arthrodesis, and amputation. [1][2][3][4][5]7,8,14,19 When treating limb deformities associated with surgical treatments in melorheostosis patients, recurrences are common. We treated our patient initially with decompression of the hyperostosis which did not improve his symptoms.…”