Clinical Outcomes of Combined Anterior and Posterior Spinal Fusion for Dystrophic Thoracolumbar Spinal Deformities of Neurofibromatosis-1

Iwai, Chizuo; Taneichi, Hiroshi; Inami, Satoshi; Namikawa, Takashi; Takeuchi, Daisaku; Kato, Nakayuki; Iida, Takuya; Shimizu, Katsuji; Nohara, Yutaka

doi:10.1097/brs.0b013e318261ec74

Cited by 20 publications

(19 citation statements)

References 13 publications

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“…There are studies that report good outcomes with the PVCR technique for the treatment of severe vertebral deformities in idiopathic, congenital, and neuromuscular deformities, 13 but the literature addressing deformities secondary to NF-1 corrected using the PVCR technique are very scarce. 6,19 In our study, we observed good results in relation to the rate of correction, consolidation, and associated complications.…”

Section: Discussionsupporting

confidence: 57%

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

et al. 2019

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Objective To evaluate the results after multiple posterior vertebral column resection (PVCR) in patients with severe kyphoscoliosis secondary to neurofibromatosis type 1 (NF-1). Methods Retrospective study of 4 adult male patients, mean age of 26.5 years, with severe rigid deformity, mean kyphosis of 122º and scoliosis of 88º, through clinical analysis and complementary exams. Results The mean postoperative follow-up was 27 months. Three vertebrae were resected on average. Interbody consolidation of arthrodesis was confirmed by CT in all cases. The correction rates of sagittal and coronal deformities were 54.09% and 70.45%, respectively. Prior to surgery, all patients were neurologically intact and as a post-surgical complication one patient had motor deficit (ASIA D) and pneumothorax also occurred in two patients. Conclusions The correction of severe kyphoscoliosis in adult patients with NF-1 is technically demanding and is not free of major complications. However, in view of the limited possibility of correction of these deformities, multiple-level PVCR has proved to be a safe and effective technique. Level of evidence IV; Case Series.

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Section: Discussionsupporting

confidence: 57%

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

et al. 2019

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“…The clinical and operative details from previous studies are shown in Table 6. Previous researchers recommended corpectomy and combined circumferential fusion to treat or correct dystrophic scoliosis in NF-1 patients 11,14,26) . Halmai et al 6) reported a series of 12 patients who underwent 3-week preoperative traction and then anterior release, posterior instrumentation and fusion were performed.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

Park

Hyun

Wui

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1). Methods : From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre-and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre-and postoperative scoliosis research society-22r (SRS-22r) score. Results : Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of-3.5±1.0. All patients underwent surgical correction via posterior approach. The pre-and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury. Conclusion : The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.

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“…[5–8,11] The anterior strut-grafting from the concavity was recommended so that the graft undergoes compressive forces and conforms to biomechanical principle. [21] With anterior support of the spine and posterior instrumented fusion, the reconstructed spine could achieve stability and solid bony fusion would be generally seen at follow-up. The difficulty of this procedure lies in the high technique requirement of anterior approach and vulnerability of reconstructed anterior column because of poor local bone stock for placing a graft.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rotational dislocation of the lumbar spine in type 1 neurofibromatosis

et al. 2019

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Rationale: Scoliosis is the most common form of dystrophic spinal deformities in type 1 neurofibromatosis, whereas a spontaneous rotational dislocation of the lumbar spine is a rare entity. Former researchers had advocated the use of circumferential fusion performed through combined anterior-posterior approaches as the mode of treatment of this situation, but we managed to achieve a solid circumferential fusion equally using posterior approach alone. Patient concerns: A 51-year-old lady presented with severe back pain and no history of trauma, fever, or loss of weight. On examination, she showed several café-au-lait spots on her body and no neurologic deficit. Diagnoses: The imageology revealed a rotational dislocation of the L2 to L3. The diagnosis of neurofibroma was confirmed by biopsy. Interventions: The patient underwent posterior reduction, combined intervertebral-posterolateral fusion, and internal fixation with screws and rods. Outcomes: The patient was satisfied with the back pain relief after surgery and able to live a normal life at follow-up. The imageology showed a good correction of the deformity with a solid bony fusion. Lessons: Special attention must be paid to patients who have neurofibromatosis and unexplained back pain for early diagnosis. Early circumferential fusion to reconstruct a stable spine is the key to treatment. Given the result of this case, the prognosis is promising following posterior surgery alone.

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Clinical Outcomes of Combined Anterior and Posterior Spinal Fusion for Dystrophic Thoracolumbar Spinal Deformities of Neurofibromatosis-1

Abstract: APSF with FSAG for dystrophic deformity in NF-1 successfully reconstructed a reliable spinal column with a rich bone stock. The FSAG and surrounding vertebral bodies were free from postoperative erosion due to dystrophic changes and maintained their stability for a long time.

Cited by 20 publications

References 13 publications

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

Correction of Severe Dystrophic Scoliosis in Neurofibromatosis 1 With Posterior Vertebral Column Resection in Multiple Levels

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

Spontaneous rotational dislocation of the lumbar spine in type 1 neurofibromatosis

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