Vascularized Fibula Strut Graft Used in Neurofibromatosis Type 1-Related Kyphosis: A Case of Almost Complete Reversal of Deformity-Induced Tetraparesis

Abstract

Study Design Case report.Objective The aim of this study is to describe a case of vascularized fibula strut graft implanted in the cervicothoracic spine of a patient with neurofibromatosis type 1–related progressive kyphosis.Methods A detailed history examination of the surgical procedures and the results of the follow-up after fibula strut graft implantation were performed. In addition, a review of the literature was conducted to access the incidence of similar cases with an almost complete reversal of a deformity-induced tetraparesis.Results A 37-year-old man with severe type 1 neurofibromatosis causing a collapsing kyphosis of the cervicothoracic spine presented in 2006 with progressive low cervical tetraparesis. Intervention included posterior stabilization (C5 to T5) which was extended to C3–T9 in 2008; however, the kyphosis continued to worsen. In 2009, a vascularized fibula strut graft was implanted between the inferior and superior endplates of C3 and T9. Over the following months, the patient gradually recovered motor strength and improved functional use of all limbs. In March 2011, lower limb (bilateral) and right arm strength was grade 5, with left arm strength being grade 4+.Conclusions This case report demonstrates the existence of a potential local option for the difficult problems of pseudoarthrosis, progressive spinal deformity, and cord compromise in patients with neurofibromatosis type 1–related kyphosis resulting in an almost complete reversal of deformity-induced tetraparesis.

Dystrophic thoracic spine dislocation associated with type-1 neurofibromatosis: Case report and rationale for treatment

“…Fibular or tibial strut grafts are the most used for anterior reconstruction in patients with thoracic dislocations associated to NF-1. [ 9 11 ] The graft can be secured between the inferior and superior endplates of two vertebral bodies aligned with the gravity line in the sagittal plane and more or less oblique in the coronal plane, as was accomplished in our case. The anterior strut-grafting must be done from the concavity, where it is put into an appropriate biomechanical situation, under compressive forces.…”

“…According to our comprehensive literature review, only nine cases of surgically-treated spontaneous vertebral column dislocation had been previously reported in the literature [ Table 1 ]. [ 3 4 5 6 7 8 9 11 ]…”

“…The anterior strut-grafting must be done from the concavity, where it is put into an appropriate biomechanical situation, under compressive forces. [ 11 ]…”

Anterior Fusion using a Vascularized Fibular Graft for Cervical Kyphosis Associated with Neurofibromatosis Type 1: A Report of Two Cases with Long-term Follow-up

“…VFG has been used successfully for multilevel fusion [ 4 ], including anterior fusion with VFG for multilevel decompression and fusion in ossification of the posterior longitudinal ligament or severe kyphotic deformity after laminectomy [ 9 ]. VFG has also been used for fusion of the dystrophic NF-1 spine [ 1 ]. Vascularized rib grafts have been used for the anterior fusion of thoracic or thoracolumbar kyphosis [ 10 ].…”

“…In other cases, posterior fixation is either mechanically unfeasible or subsequently proves to be inadequate due to breakage [ 1 ]. Vascularized fibular grafts (VFG) in the cervicothoracic spine have been used for patients with progressive NF-1-related kyphosis [ 1 , 2 ], but the long-term outcomes of VFG with NF-1 are not well described. Here, we describe two long-term follow-up cases of cervical spine VFG for NF-1-related cervical kyphosis.…”