Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck–Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years

Background and purpose — Van Neck–Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by a symptomatic or asymptomatic uni- or bilateral overgrowth of the pre-pubescent ischiopubic synchondrosis. It is frequently misinterpreted as a neoplastic, traumatic, or infectious process, often resulting in excessive diagnostic and therapeutic measures. This study assessed the demographic, clinical, and radiographic features of the condition and analyzed diagnostic and therapeutic pathways in a large single-center cohort.Patients and methods — We retrospectively analyzed 21 consecutive patients (13 male) with a median age of 10 years (IQR 8–13) and a median follow-up of 5 years (IQR 42–94 months), who were diagnosed at our department between 1995 and 2019.Results — VND was unilateral in 17 cases and bilateral in 4 cases. Initial referral diagnoses included suspected primary bone tumor (n = 9), fracture (n = 3), osteomyelitis (n = 2), and metastasis (n = 1). The referral diagnosis was more likely to be VND in asymptomatic than symptomatic patients (4/6 vs. 2/15). More MRI scans were performed in unilateral than bilateral VND (median 2 vs. 0). All 15 symptomatic patients underwent nonoperative treatment and reported a resolution of symptoms and return to physical activity after a median time of 5 months (IQR 0–6).Interpretation — By understanding the physiological course of VND during skeletal maturation, unnecessary diagnostic and therapeutic measures can be avoided and uncertainty and anxiety amongst affected patients, their families, and treating physicians can be minimized.

Van Neck–Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by an asymptomatic or symptomatic uni- or bilateral overgrowth of the pre-pubescent junction between the inferior pubic ramus and ischium, which can be seen on radiographs during skeletal maturation (Figure 1) (Herneth et al. 2004, Wait et al. 2011, Mixa et al. 2017). The condition was first described in the 1920s by Odelberg and Van Neck, who classified it as a “disease” (Odelberg 1923, van Neck 1924). Today, however, VND is considered a physiological normal variant of the ischiopubic synchondrosis (IPS) that is usually obliterated between late childhood and early adolescence by bony fusion or synostosis (Herneth et al. 2000, Mixa et al. 2017).Open in a separate windowFigure 1.Typical enlargement of the IPS in a 14-year-old female patient with right-sided VND.Despite VND being considered a normal variant, unilateral radiographic changes of the IPS are frequently misinterpreted as neoplastic, traumatic, or infectious processes (Herneth et al. 2000, Wait et al. 2011). Particularly in symptomatic patients, this often results in excessive, unnecessary, invasive, and costly diagnostic measures causing uncertainty and anxiety amongst patients and their families, as well as treating physicians (Herneth et al. 2000, Wait et al. 2011).There are several case reports on VND in the literature; however, there are only 1 small series of 10 cases and 1 systematic review of 29 patients available, providing only limited data on demographics, possible diagnostic and therapeutic pathways, and patient outcome (Wait et al. 2011, Mixa et al. 2017). We therefore conducted this study to assess demographic, clinical, and radiographic features of VND, analyze the course of the disease, and evaluate the functional follow-up in a large single-center cohort. Based on these data, we additionally developed a standardized algorithm to help minimize the use of unnecessary diagnostic measures and to simplify diagnosis.