Cervical Spine Involvement in Morphea Patients With Subclinical Neurologic Signs

Morphea is a rare skin disease that involves the fibrosis of subcutaneous tissues. Several subtypes of morphea, such as linear and deep variants, may affect musculoskeletal structures and produce neurologic manifestations. However, morphea is differentiated from systemic scleroderma by the absence of internal organ damage. Although the prognosis of a morphea diagnosis is generally favorable, systemic involvement can be severe. However, early detection may improve disease management. The relationship between morphea and its involvement in the cervical spine remains incompletely characterized. As such, this narrative review examines cervical spine involvement in patients with morphea. OpenEvidence, PubMed, and Google Scholar databases were used to identify relevant articles. MeSH terms included “scleroderma, localized”, “cervical vertebrae”, and “neurologic manifestations”. Keywords searched included “morphea”, “cervical”, “neurologic”, and “subclinical”. The search was restricted to English-language articles written in the last 10 years. In addition to the database searches, independent reviewers performed a thorough citation search and included studies relevant to the topic. The information in the articles was assessed to determine relevant signs and symptoms in patients with morphea that had cervical spine involvement. Almost half of all head-and-neck morphea patients presented with an abnormal MRI finding. Some patients presented with incidental findings, such as white matter lesions or vascular malformations, and later developed clinical symptoms, including seizures or migraines. Additionally, the hardening of subcutaneous tissues in the cervical spine can obstruct the neurovasculature, ranging from subtle to significant. Fleeting symptoms such as recurrent numbness or tingling can indicate invasive tissue growth. Although the disease is generally self-limiting, surgery is indicated in cases of contracture, while some patients may opt for cosmetic operations. Although morphea starts as a disease of the skin, it can advance to affect the underlying tissues. Several cases have documented the dangerous effects of the disease when infiltrative tissue growth affects organ systems beneath the skin. Periodic imaging studies, careful physical exam, and detailed history taking aid in the early diagnosis of the disease. For this reason, it is necessary to follow up with morphea patients regularly to observe the progression of the disease.