Treatment of dystrophic scoliosis in neurofibromatosis Type 1 with one-stage posterior pedicle screw technique

Wang, Zhenyu; Fu, Changfeng; Leng, Jiali; Qu, Zhigang; Xu, Feng; Liu, Yi

doi:10.1016/j.spinee.2014.10.014

Cited by 24 publications

(30 citation statements)

References 35 publications

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“…The authors suggested that posterior approach is safe and effective method. Wang et al 31) reported a series of 16 patients who underwent one-stage posterior surgery with pedicle screw system. Mean scoliosis and kyphosis improved from 83.2° to 27.6° and 58.5° to 26.8°, respectively.…”

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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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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“…This study intends to support the thesis of the effectiveness of posterior-only spinal fusion in dystrophic scoliotic curves. [ 22 23 24 25 26 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 27 28 29 30 ] According to other authors, modern instrumentations could be sufficient to sustain a solid and effective posterior arthrodesis. [ 22 23 24 25 26 31 ]…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of scoliosis in neurofibromatosis type I: A retrospective study on posterior-only correction with third-generation instrumentation

Cinnella

Amico

Rava

et al. 2020

J Craniovert Jun Spine

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Background: Scoliosis is the most common orthopedic complication of neurofibromatosis type I. Scoliosis can be occurred with two patterns: dystrophic or idiopathic-like. In adolescence, in consideration of bone dystrophy, osteopenia, and often associated hyperkyphosis, most of the authors recommend an anterior-posterior approach. According to other authors, modern instrumentations could be sufficient to sustain a solid posterior arthrodesis. Materials and Methods: Ten patients were diagnosed with scoliosis in neurofibromatosis type I aged between 8 and 25 years, Cobb angle of the thoracic curve >45°, and minimum follow-up (FU) of 1 year and treated with posterior-only approach with third-generation high-density instrumentations. Radiographic measurements were performed on the coronal and sagittal planes. Nonparametric tests (Friedman test and Wilcoxon test) were applied to evaluate the reducibility of the preoperative curve (T0), the postoperative surgical correction (T1), and its maintenance on FU. Results: Statistics showed results compared to those evaluated in the literature with a combined approach regarding surgical correction and its maintenance on FU. On T1, a median correction of 53.5% of the scoliotic curve and of 33.7% of the thoracic hyperkyphosis was observed. On FU, the correction was maintained. A global improvement in balance was appreciated. The curves, despite rigid, showed a relative reducibility to bending tests and traction. No significant complications occurred. Conclusions: The posterior-only approach produces a satisfactory correction of the dystrophic neurofibromatosis scoliosis if associated with the use of high-density third-generation instrumentations. We are confident in recommending posterior-only approach in dystrophic neurofibromatosis scoliosis with coronal curves till 110° and coexisting thoracic kyphosis till 80°

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“…However, only a few case series have presented clinical results regarding the treatment of dystrophic NF scoliosis using pedicle screw constructs. [29–31] The dysplasia of pedicles increased the challenge of pedicle screw insertion.…”

Section: Discussionmentioning

confidence: 99%

Pedicle screw versus hybrid posterior instrumentation for dystrophic neurofibromatosis scoliosis

et al. 2017

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Surgical management of severe rigid dystrophic neurofibromatosis (NF) scoliosis is technically demanding and produces varying results. In the current study, we reviewed 9 patients who were treated with combined anterior and posterior fusion using different types of instrumentation (i.e., pedicle screw, hybrid, and all-hook constructs) at our institute.Between September 2001 and July 2010 at our institute, 9 patients received anterior release/fusion and posterior fusion with different types of instrumentation, including a pedicle screw construct (n = 5), a hybrid construct (n = 3), and an all-hook construct (n = 1). We compared the pedicle screw group with the hybrid group to analyze differences in preoperative curve angle, immediate postoperative curve reduction, and latest follow-up curve angle.The mean follow-up period was 9.5 ± 2.9 years. The average age at surgery was 10.3 ± 3.9 years. The average preoperative scoliosis curve was 61.3 ± 13.8°, and the average preoperative kyphosis curve was 39.8 ± 19.7°. The average postoperative scoliosis and kyphosis curves were 29.7 ± 10.7° and 21.0 ± 13.5°, respectively. The most recent follow-up scoliosis and kyphosis curves were 43.4 ± 17.3° and 29.4 ± 18.9°, respectively. There was no significant difference in the correction angle (either coronal or sagittal), and there was no significant difference in the loss of sagittal correction between the pedicle screw construct group and the hybrid construct group. However, the patients who received pedicle screw constructs had significantly less loss of coronal correction (P < .05). Two patients with posterior instrumentation, one with an all-hook construct and the other with a hybrid construct, required surgical revision because of progression of deformity.It is difficult to intraoperatively correct dystrophic deformity and to maintain this correction after surgery. Combined anterior release/fusion and posterior fusion using either a pedicle screw construct or a hybrid construct provide similar curve corrections both sagittally and coronally. After long-term follow-up, sagittal correction was maintained with both constructs. However, patients treated with posterior instrumentation using pedicle screw constructs had significantly less loss of coronal correction.

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Treatment of dystrophic scoliosis in neurofibromatosis Type 1 with one-stage posterior pedicle screw technique

Cited by 24 publications

References 35 publications

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

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

Surgical treatment of scoliosis in neurofibromatosis type I: A retrospective study on posterior-only correction with third-generation instrumentation

Pedicle screw versus hybrid posterior instrumentation for dystrophic neurofibromatosis scoliosis

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