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Neifert SN, Khan HA, Kurland DB, Kim NC, Yohay K, Segal D, Samdani A, Hwang S, Lau D. Management and surgical outcomes of dystrophic scoliosis in neurofibromatosis type 1: a systematic review. Neurosurg Focus 2022; 52:E7. [DOI: 10.3171/2022.2.focus21790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Neurofibromatosis type 1 (NF1) dystrophic scoliosis is an early-onset, rapidly progressive multiplanar deformity. There are few studies on the surgical management of this patient population. Specifically, perioperative morbidity, instrument-related complications, and quality-of-life outcomes associated with surgical management have not been systematically evaluated. In this study, the authors aimed to perform a systematic review on the natural history, management options, and surgical outcomes in patients who underwent NF1 dystrophic scoliosis surgery.
METHODS
A PubMed search for articles with “neurofibromatosis” and either “dystrophic” or “scoliosis” in the title or abstract was performed. Articles with 10 or more patients undergoing surgery for NF1 dystrophic scoliosis were included. Data regarding indications, treatment details, morbidity, and outcomes were summarized and analyzed with descriptive statistics.
RESULTS
A total of 310 articles were identified, 48 of which were selected for full-text review; 30 studies describing 761 patients met the inclusion criteria. The mean age ranged from 7 to 22 years, and 99.7% of patients were younger than 18 years. The mean preoperative coronal Cobb angle was 75.2°, and the average correction achieved was 40.3°. The mean clinical follow-up in each study was at least 2 years (range 2.2–19 years). All patients underwent surgery with the intent of deformity correction. The scoliosis regions addressed were thoracic curves (69.6%) and thoracolumbar (11.1%) and lumbar (14.3%) regions. The authors reported on a variety of approaches: posterior-only, combined anterior-posterior, and growth-friendly surgery. For fixation techniques, 42.5% of patients were treated with hybrid constructs, 51.5% with pedicle screw–only constructs, and 6.0% with hook-based constructs. Only 0.9% of patients underwent a vertebral column resection. The nonneurological complication rate was 14.0%, primarily dural tears and wound infections. The immediate postoperative neurological deficit rate was 2.1%, and the permanent neurological deficit rate was 1.2%. Ultimately, 21.5% required revision surgery, most commonly for implant-related complications. Loss of correction in both the sagittal and coronal planes commonly occurred at follow-up. Five papers supplied validated patient-reported outcome measures, showing improvement in the mental health, self-image, and activity domains.
CONCLUSIONS
Data on the surgical outcomes of dystrophic scoliosis correction are heterogeneous and sparse. The perioperative complication rate appears to be high, although reported rates of neurological deficits appear to be lower than clinically observed and may be underreported. The incidence of implant-related failures requiring revision surgery is high. There is a great need for multicenter prospective studies of this complex type of deformity.
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Affiliation(s)
- Sean N. Neifert
- Department of Neurological Surgery, New York University, New York, New York
| | - Hammad A. Khan
- Department of Neurological Surgery, New York University, New York, New York
| | - David B. Kurland
- Department of Neurological Surgery, New York University, New York, New York
| | - Nora C. Kim
- Department of Neurological Surgery, New York University, New York, New York
| | - Kaleb Yohay
- Department of Neurology and Comprehensive Neurofibromatosis Center, New York University, New York, New York; and
| | - Devorah Segal
- Department of Neurology and Comprehensive Neurofibromatosis Center, New York University, New York, New York; and
| | - Amer Samdani
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Steven Hwang
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Darryl Lau
- Department of Neurological Surgery, New York University, New York, New York
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Estefan MM, Camino-Willhuber G, Bosio ST, Puigdevall M, Maenza RA. Management of NF-1 dystrophic scoliosis associated with rib heads dislocation into the spinal canal in neurological intact patients: a systematic literature review. Spine Deform 2022; 10:285-294. [PMID: 34705252 DOI: 10.1007/s43390-021-00422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The management of scoliosis and kyphoscoliosis in patients with Type 1 Neurofibromatosis (NF-1) among spinal surgeons is still challenging due to the severity of the deformity especially in dystrophic deformity types. This rapid and progressive condition is likely to be associated with dislocated rib heads into the spinal canal, hence representing a real dilemma on the decision making between its resection versus not resection during the corrective surgery, especially in patients with normal neurological status. The objective of this publication is to discuss the management options in this patient population through a literature review. METHODS A comprehensive systematic literature search was performed for relevant studies using PubMed, Web of Science, and Scopus databases. Previous publications depicting neurologically intact patients with NF-1 and rib dislocation into the canal were reviewed. Articles reporting individual cases or case series/cohorts with patient-discriminated findings were included. RESULTS The data collection retrieved a total of 55 neurologically intact patients with NF-1 dystrophic scoliosis and rib penetration into the canal who underwent spinal surgery. Among them, 37 patients underwent surgery without head rib resection and 18 patients with rib excision. No patient presented postoperative neurological deficit except for one case of late postoperative neurological deterioration reported in a patient within situ fusion in which the surgeons ignored the presence of previous spinal cord compression. CONCLUSION Corrective surgery for patients with NF-1 and rib penetration into the canal in neurologically intact patients can be safely performed without the resection of the dislocated rib heads without a higher risk of neurological compromise.
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Affiliation(s)
- Martin M Estefan
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. .,The Centre for Spinal Studies and Surgery (CSSS)- Queen's Medical Centre, Nottingham University Hospitals-NHS, Nottingham, United Kingdom.
| | - Gaston Camino-Willhuber
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago T Bosio
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Miguel Puigdevall
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ruben A Maenza
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Pushpa BT, Rajasekaran S, Anand KSSV, Shetty AP, Kanna RM. Anatomical changes in vertebra in dystrophic scoliosis due to neurofibromatosis and its implications on surgical safety. Spine Deform 2022; 10:159-167. [PMID: 34309821 DOI: 10.1007/s43390-021-00392-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/17/2021] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Detailed radiological analysis by multimodality imaging. OBJECTIVE To document anatomical changes jeopardizing instrumentation safety in Neurofibromatosis deformity correction surgeries. MATERIALS AND METHODS The apical and 3 adjacent vertebral segments above and below amounting to 70 segments in 10 NF scoliosis were studied by radiographs, CT and MRI. The changes in lamina, pedicle and vertebral body that could jeopardize pedicle screw and sublaminar wire placement were documented and changes were appropriately classified. RESULTS Extensive anatomical changes were noted. These changes were more severe at the apex and independent of the curve severity. Both laminae were normal in only 36 (Type 1), rest had either gross asymmetry in length and shape (Type 2; 21) or also in sloping (Type 3; 13). Of the 140 pedicles, normal pedicles were found only in 48 (Type 1); while they were divergent (Type 2; 4) or abnormally elongated with only thinning (Type 3a; 26); or with sclerosis (3b; 34); or very curved and wavy (3c; 23) and even fractured or indistinct (Type 4; 5). It was notable that 92 of the 140 pedicles were unsuitable for pedicle screws. A unique phenomenon of body drift was identified in 29 segments which could jeopardize screw placement and rib dislocation into the canal was found in 18 segments. CONCLUSION Gross anatomical changes jeopardizing both sublaminar wire strength and trajectory of pedicle screws were common in NF and independent of curve severity. Therefore, detailed preoperative assessment and planning by a 3D CT are essential.
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Affiliation(s)
- B T Pushpa
- Department of Radiodiagnosis, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, India.
| | - K S Sri Vijay Anand
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, India
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