Posterior-only surgical correction of dystrophic scoliosis in 31 patients with neurofibromatosis Type 1 using the multiple anchor point method

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The objective of this study was to evaluate the clinical efficacy of posterior-only surgical correction of dystrophic scoliosis in patients with neurofibromatosis Type 1 (NF1) using a multiple anchor point method (MAPM).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>From 2005 to 2014, 31 patients (mean age 13.5 years old, range 10–22 years old) suffering from dystrophic scoliosis associated with NF1 underwent posterior-only surgical correction using a MAPM. The apex of the deformity was thoracic (n = 25), thoracolumbar (n = 4), and lumbar (n = 2). The mean preoperative coronal Cobb angle was 69.1° (range 48.9°–91.4°). The mean Cobb angle on the side-bending radiograph of the convex side was 58.2° (range 40°–79.8°). The mean flexibility and apical vertebral rotation (AVR) were 15.6% (range 8.3%–28.2%) and 2.5° (range 2°–3°), respectively. The mean angle of sagittal kyphosis was 58.3° (range 34.1°–79.6°).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The mean follow-up period was 53 months (range 12–96 months). The mean postoperative coronal Cobb angle was 27.4° (range 16.3°–46.7°). Postoperatively, the mean AVR and angle of sagittal kyphosis were 1.2° (range 1°–2°) and 22.4° (range 4.2°–36.3°), respectively. All patients showed good correction of all indices postoperatively. The mean postoperative correction rate was 58.7% (range 46.3%–74.1%). At the final follow-up evaluation, the corrective loss rate of the Cobb angle was only 2.3%. Only 1 patient required revision surgery. No severe complications such as spinal cord, neural, or large vascular injury occurred during the operation.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Posterior-only surgical correction of dystrophic scoliosis in patients with NF1 using a MAPM could yield satisfactory clinical efficacy of correction and fusion.</jats:p></jats:sec>

Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

“…The clinical outcome of dystrophic scoliosis patients treated with posterior-only fusion by using hooks and rods demonstrated that the pseudarthrosis rate was high and curve progression was common [17]. Recently, some good results of posterior only fusion surgeries in NF-1 patients with dystrophic scoliosis have been reported [9,10,19]. In this study, we reported our results about the posterior only fusion procedure in NF-1 patients with EOS.…”

“…. Recently, the posterior only instrument fusion was reported to be used to treat dystrophic scoliosis in NF-1 patients because challenges for the anterior approach caused by the extensive plexiform tumors could be avoided by using posterior approach and a good short-term result from posterior approach has been reported [9,10]. In Li and his colleagues' study, the posterior only approach demonstrated a good short-term result to treat early-onset scoliosis (EOS) in a group of NF-1 patients with an average age of 13 (the youngest patient was 8 years old), but the number of included patients were not addressed [10].…”

Evaluation of Efficacy and Safety of All Pedicle Screw Posterior-Only Surgery in Patients with Dystrophic Neurofibromatosis Scoliosis

“…18,20 In this study, scoliotic curves up to 90 • with flexibility index up to 25% and kyphosis up to 90 • were corrected posteriorly only. Li et al 20 and Deng et al 8 reported similar good results using posterioronly surgery. We think that posterior-only surgery may not be sufficient in dystrophic NF-1 scoliosis curves in the presence of small scalloped deficient apical vertebral bodies that cannot share load and that lead to insufficient apical screw density less than 30%.…”

“…The mean follow-up period was 5.15±1.78 years (range, [3][4][5][6][7][8]. The mean operative time was 195±20.12 minutes (range, 160-240) and the mean amount of blood loss was 895.…”

“…The aim of surgical treatment of these dystrophic curves is to decrease curve magnitude and have a stable spinal fixation to achieve solid bony fusion in a balanced position and prevent progression of deformity and to do these safely rather than doing a heroic unsafe surgery. 8 Anterior-posterior surgery was the traditional treatment of dystrophic NF-1 scoliosis because posterior fixation alone has been associated with increased incidence of failure and loss of correction by many studies. 15,18,19,23,24 But these studies were using either the Harrington distraction rod, hooks system, or hybrid instrumentation.…”