Spinal Reconstruction with Pedicle Screw-Based Instrumentation and rhBMP-2 in Patients with Neurofibromatosis and Severe Dural Ectasia and Spinal Deformity

Cho, Samuel K.; Stoker, Geoffrey E.

doi:10.2106/jbjs.j.01659

Cited by 15 publications

(15 citation statements)

References 56 publications

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“…There were some successful deformity correction and fusion cases by using recombinant human bone morphogenetic protein (rh-BMP) 2 3) . However, in Republic of Korea, rh-BMP is not officially available yet.…”

Section: Discussionmentioning

confidence: 99%

Posterior Spinal Reconstruction with Pedicle Screws, Multiple Iliac Screws and Wisconsin Spinal Wires in a Patient with Neurofibromatosis Scoliosis: A Case Report

Kim

Park

et al. 2015

Korean J Spine

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A 54-year-old female with neurofibromatosis type 1 presented with progressing truncal shift owing to spinal deformity. On plain radiograph, the Cobb angle was 54 degree in coronal plane. Radiological examinations showed severe dystrophic change with dysplastic pedicles, bony scalloping, neural foraminal widening from dural ectasia. The patient underwent deformity correction and reconstruction surgery from the T9 to the pelvis using multiple iliac screws and Wisconsin interspinous segmental instrumentation by wiring due to maximize fixation points. The postoperative course was uneventful. One-year follow-up radiographs showed a successful curve correction with solid fusion. We report a case of pedicle dysplasia and dystrophic change treated by posterior segmental spinal instrumentation and fusion with help of multiple iliac screws and modified Wisconsin interspinous segmental wiring.

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Section: Discussionmentioning

confidence: 99%

Posterior Spinal Reconstruction with Pedicle Screws, Multiple Iliac Screws and Wisconsin Spinal Wires in a Patient with Neurofibromatosis Scoliosis: A Case Report

Kim

Park

et al. 2015

Korean J Spine

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“…Where the pathology has been associated with spinal instability/deformity, surgery has been directed to stabilize the spine through reconstruction, instrumentation, and fusion. [ 29 33 39 40 41 ] Where the pathology has been associated with postural headaches, conservative management has had some success, including flat bed rest, hydration, and blood patch. [ 1 31 32 ] Treatment assumes that the postural headaches due to a “cerebrospinal fluid sink” mechanism, which causes traction on pain-sensitive structures such as cranial nerves, dura, and meninges; however, imaging to seek the site of a CSF leak associated with dural estasia has predominantly been negative.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 31 32 ] Surgery has been performed for persistent symptoms or CES. General methods have revolved around surgical bony decompression, followed by thecal sac reconstruction[ 33 34 ] with possible lumboperitoneal shunt placement. [ 26 ]…”

Section: Introductionmentioning

confidence: 99%

Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient

Nguyen

Lozen

Doan

et al. 2015

J Craniovert Jun Spine

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Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA) to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to limit the expansile dura, reducing the cerebrospinal fluid sump and the potential for intracranial hypotension.

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“…Treatment should follow standard bracing guidelines with surgical intervention for curves over 50°. There is a small risk of nondystrophic scoliosis modulating into a dystrophic curve, so close radiographic observation is necessary [48]. Dystrophic curves tend to be highly rotated with sharp angles involving a short segment, penciling of ribs, scalloping of the vertebral bodies, and widening of the interpedicular distance.…”

Section: Neurofibromatosismentioning

confidence: 99%

Pediatric scoliosis

Cunningham

2011

Curr Rev Musculoskelet Med

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Pediatric scoliosis is a relatively uncommon condition typically first noticed due to altered stature or by routine spine screenings by a school nurse or pediatrician. The formal diagnosis is made with spine radiographs, with coronal curvature measurement of 10° or greater. Treatment may consist of serial observation, bracing until skeletal maturity, or surgery for correction and fusion/stabilization of severe or progressive deformity. Overall success for non-operative management of scoliosis is affected by the etiology for the deformity, close follow up and monitoring for evolution of the deformity, and patient compliance with their treatment regimen. The most common surgical technique is a posterior approach spine fusion with implanted instrumentation, and patients are typically back to their activities of daily living by 6 months postoperatively. Continued intermittent monitoring of the scoliosis throughout adulthood is recommended, to detect late deformity progression, development of arthritis symptoms, or other associated issues.

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Spinal Reconstruction with Pedicle Screw-Based Instrumentation and rhBMP-2 in Patients with Neurofibromatosis and Severe Dural Ectasia and Spinal Deformity

Cited by 15 publications

References 56 publications

Posterior Spinal Reconstruction with Pedicle Screws, Multiple Iliac Screws and Wisconsin Spinal Wires in a Patient with Neurofibromatosis Scoliosis: A Case Report

Posterior Spinal Reconstruction with Pedicle Screws, Multiple Iliac Screws and Wisconsin Spinal Wires in a Patient with Neurofibromatosis Scoliosis: A Case Report

Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient

Pediatric scoliosis

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