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Sacco R, Fuxing X, Yiqiang L, Xu H, Canavese F. Uninstrumented fusion in cervical kyphosis due to neurofibromatosis type I: report of two paediatric cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2846-2853. [PMID: 37993743 DOI: 10.1007/s00586-023-08039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/09/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Severe cervical kyphosis (CK) in neurofibromatosis type 1 (NF-1) is associated with a high risk for progression and neurologic impairment in children. We present our surgical technique and mid-term outcomes of uninstrumented anterior tibial strut grafting for severe CK secondary to NF-1. METHODS Case report. The Consensus-based Clinical Case Reporting Guideline Development (CARE) guidelines were followed. RESULTS Two paediatric patients (8- and 3-year-old) presented with severe CK secondary to NF-1. A halo body jacket (HV) allowed the progressive distraction of the cervical spine, avoiding neurological compromise and deformity progression. Circumferential fusion was obtained with anterior tibial strut autograft and posterior onlay bone graft. Cervical spine fusion was successfully maintained at a minimum 4-year follow-up in both patients. CONCLUSION In children with severe CK secondary to NF-1, cervical distraction and immobilisation with a HV followed by uninstrumented anterior tibial strut grafting and posterior bone grafting, provided spinal fusion and stability without increasing the risk of neurological injury and donor site morbidity. The reported surgical technique appears to be a valuable tool in the armamentarium of the spinal surgeon.
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Affiliation(s)
- Riccardo Sacco
- Department of Orthopedic Surgery, CHU de Rouen, 76000, Rouen, France
| | - Xun Fuxing
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - Li Yiqiang
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - HongWen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopaedic Surgery, Jeanne de Flandre Hospital, CHU de Lille, Rue Eugène Avinée, 59037, Lille Cedex, France.
- Department of Pediatric Orthopedic Surgery, University Hospital Estaing, 1 Place Lucie Et Raymond Aubrac, 63003, Clermont Ferrand, France.
- Faculty of Medicine, Nord-de-France Lille University, 59000, Lille, France.
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Murlidharan S, Singh PK, Chandra PS, Agarwal D, Kale SS. Surgical challenges and functional outcomes in dystrophic cervical kyphosis in Neurofibromatosis -1: an institutional experience. Spine Deform 2022; 10:697-707. [PMID: 35050492 DOI: 10.1007/s43390-021-00465-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Dystrophic cervical kyphosis secondary to neurofibromatosis 1 (NF1) is rarely reported. The primary objective is to highlight the clinical presentation and surgical outcomes based on clinical and biomechanical parameters. The secondary objective is to highlight the early and late complications of these surgeries. METHODS The hospital records of six patients operated between 2008 and 2018 were retrospectively reviewed with a minimum follow-up of 24 months. Besides demographics information, radiological findings and operative details, the outcome measures reported were neurological (MJOA score, Nurick scale), pain (VAS score) and operative complications. RESULTS The mean age of patients was 15.1 years (8-32 years). The average kyphotic vertebra involved-3.6 bodies (range 2-5 bodies) with four patients showing intraspinal anomaly-neurofibromas, dural ectasia. Clinically, patients improved postoperatively with-VAS (pre vs. post-: 6.6 vs. 2.6, p - < 0.05), MJOA score (pre vs. post: 10.3 vs. 13.3, p - < 0.05), Nurick grade (pre vs. post: 3.5 vs. 2.1, p - < 0.05). There was significant deformity correction from 66.8° to 20.7° (p value < 0.031), mean T1 Slope (pre vs. post - 1.8 ± 20.4 to 0.6 ± 12.8, p value - < 0.43). Mean blood loss encountered was 1800 ± 434.6 cc; however, patients with paraspinal neurofibromas reported greater blood loss. Late complications included pseudoarthrosis (1), C5 palsy (1) and junctional kyphosis (1). Vertebral dysplasia and erosions continued in all patients post-operatively. CONCLUSIONS Antero-posterior approach provides circumferential decompression and better sagittal balance correction. Cervical spine must be screened in all NF-1 patients and followed up regularly to assess for dystrophic changes.
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Affiliation(s)
- Shrijith Murlidharan
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, Room No 720, 7th Floor, C.N. Tower, New Delhi, 110029, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, Room No 720, 7th Floor, C.N. Tower, New Delhi, 110029, India
| | - P Sarat Chandra
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, Room No 720, 7th Floor, C.N. Tower, New Delhi, 110029, India
| | - Deepak Agarwal
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, Room No 720, 7th Floor, C.N. Tower, New Delhi, 110029, India
| | - Shashank Sharad Kale
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, Room No 720, 7th Floor, C.N. Tower, New Delhi, 110029, India.
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Friedrich RE, Scheuer HT, Kersten JF, Scheuer HA. Sphenoid Bone Pneumatisation on Lateral Cephalograms of Patients With Neurofibromatosis Type 1. In Vivo 2021; 35:349-361. [PMID: 33402484 DOI: 10.21873/invivo.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disease that causes tumors and many developmental disorders, e.g., cranial dysplasia. The purpose of this retrospective study was to analyse the pneumatisation of the sphenoid bone in NF1. PATIENTS AND METHODS The anonymised lateral cephalograms of 166 NF1 patients and 166 age- and sex-matched controls were examined for anterior-posterior sphenoid pneumatisation. The patient group analysis considered whether the patients had been affected by a facial plexiform neurofibroma (FPNF). RESULTS Sphenoid pneumatisation was significantly lower in NF1 patients than in controls [odds ratio (OR)=0.184; 95%CI=0.11-0.32; p<0.001]. A FPNF statistically significantly reduced sinus formation in patients (OR=0.38; p=0.002). CONCLUSION The condition 'NF1' has an effect on sphenoid pneumatisation. The findings are relevant for planning surgical procedures in this region and confirm current concepts to evaluate NF1 as a histogenesis control gene. The examination technique and basis of calculation presented here are easy-to-use and low-irradiation exposure instruments for screening for differences in sphenoid bone pneumatisation in defined populations.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; .,Neurofibromatosis Laboratory, Hamburg, Germany
| | - Hannah T Scheuer
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany.,Neurofibromatosis Laboratory, Hamburg, Germany
| | - Jan F Kersten
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna A Scheuer
- Orthodontic Practice, Hamburg-Lokstedt, Hamburg, Germany.,Department of Orthodontics, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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Jackson S, Baker EH, Gross AM, Whitcomb P, Baldwin A, Derdak J, Tibery C, Desanto J, Carbonell A, Yohay K, O’Sullivan G, Chen AP, Widemann BC, Dombi E. The MEK inhibitor selumetinib reduces spinal neurofibroma burden in patients with NF1 and plexiform neurofibromas. Neurooncol Adv 2020; 2:vdaa095. [PMID: 32939452 PMCID: PMC7486535 DOI: 10.1093/noajnl/vdaa095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Spinal neurofibromas (SNFs) in neurofibromatosis type 1 (NF1) can cause progressive spinal cord compression and neurological dysfunction. The MEK inhibitor selumetinib shrinks the majority of plexiform neurofibromas (PNs) in patients with NF1. We assessed the effect of selumetinib on SNF. METHODS Pediatric and adult patients with NF1 and inoperable PN participating in phase 2 studies of selumetinib for PN were included in this analysis if they had SNF and serial spine magnetic resonance imaging (MRI). Selumetinib was administered orally at the recommended dose of 25 mg/m2/dose twice daily (max 50 mg b.i.d.; 1 cycle = 28 days). We qualitatively assessed the effect of selumetinib on SNF-related spinal canal distortion, cerebrospinal fluid distribution, and spinal cord deformity on MRI. RESULTS Twenty-four patients (18 male), median age 16.9 years (range, 6.2-60.3), had SNF, 22 of which were associated with the same nerves as the target PN assessed on the clinical trial. Twenty patients had spinal cord deformity. Twenty-three patients completed at least 12 treatment cycles to date. Eighteen patients showed subtle to a marked improvement in SNF burden, 5 remained stable, and no worsening was observed during treatment. CONCLUSIONS This is the first study describing the effect of selumetinib on SNF. Of 24 patients, 18 exhibited some improvement of SNF burden on imaging. These findings suggest that selumetinib may prevent the worsening of cord compression, potentially reducing the need for surgical interventions in select patients or benefitting patients who do not have a surgical option. Prospective evaluation of the clinical benefit of selumetinib for SNF is warranted.
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Affiliation(s)
- Sadhana Jackson
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Eva H Baker
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea M Gross
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Patricia Whitcomb
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Andrea Baldwin
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Joanne Derdak
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Cecilia Tibery
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Jennifer Desanto
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Amanda Carbonell
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Kaleb Yohay
- Departments of Neurology and Pediatrics, NYU Langone Health, New York, New York, USA
| | - Geraldine O’Sullivan
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
| | - Alice P Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
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