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Posterior vertebral column resection for the treatment of dystrophic kyphosis associated with type-1 neurofibromatosis: a case report and review of the literature.
Spine (Phila Pa 1976). 2012 Dec 15; 37(26):E1659-64.S

Abstract

STUDY DESIGN

Case report.

OBJECTIVE

To describe the use of posterior-only vertebral column resection and postoperative traction for spinal deformity associated with type-1 neurofibromatosis (NF1).

SUMMARY OF BACKGROUND DATA

Vertebral deformity, namely, thoracic scoliosis, is the predominant orthopedic manifestation of NF1. Patients may present with debilitating pain and rarely, myelopathy. The commonly dystrophic nature of these deformities makes them particularly recalcitrant to surgical correction. Traditionally, circumferential arthrodesis via combined anterior and posterior approaches has been recommended.

METHODS

Clinical and radiographical case review.

RESULTS

A 14-year-old adolescent boy with NF1, severe cervicothoracic angular kyphosis, thoracic dislocation, and myelopathy presented status postmultiple anterior and posterior spinal fusions. The patient underwent posterior-only vertebral column resection after 6 weeks of halo-gravity traction. The surgery consisted of thoracic laminectomies, total corpectomies of T3 and T4, circumferential fusion, and posterior instrumentation from the occiput to T11. Autologous rib and iliac crest grafts were used as fusion substrate. Postoperatively, a halo vest was worn for 4 months to support the correction of his chin-on-chest deformity. The patient's neurological status returned to normal by 6 weeks postoperatively, and solid fusion was radiologically evident after 1 year.

CONCLUSION

We think that posterior-only vertebral column resection represents a safe and efficacious but technically challenging option for the treatment of angular kyphotic spinal deformity and associated neurological deficit in patients with NF1.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

23044623

Citation

Stoker, Geoffrey E., et al. "Posterior Vertebral Column Resection for the Treatment of Dystrophic Kyphosis Associated With Type-1 Neurofibromatosis: a Case Report and Review of the Literature." Spine, vol. 37, no. 26, 2012, pp. E1659-64.
Stoker GE, Lenke LG, Dorward IG. Posterior vertebral column resection for the treatment of dystrophic kyphosis associated with type-1 neurofibromatosis: a case report and review of the literature. Spine. 2012;37(26):E1659-64.
Stoker, G. E., Lenke, L. G., & Dorward, I. G. (2012). Posterior vertebral column resection for the treatment of dystrophic kyphosis associated with type-1 neurofibromatosis: a case report and review of the literature. Spine, 37(26), E1659-64. https://doi.org/10.1097/BRS.0b013e3182770aa2
Stoker GE, Lenke LG, Dorward IG. Posterior Vertebral Column Resection for the Treatment of Dystrophic Kyphosis Associated With Type-1 Neurofibromatosis: a Case Report and Review of the Literature. Spine. 2012 Dec 15;37(26):E1659-64. PubMed PMID: 23044623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior vertebral column resection for the treatment of dystrophic kyphosis associated with type-1 neurofibromatosis: a case report and review of the literature. AU - Stoker,Geoffrey E, AU - Lenke,Lawrence G, AU - Dorward,Ian G, PY - 2012/10/10/entrez PY - 2012/10/10/pubmed PY - 2013/5/28/medline SP - E1659 EP - 64 JF - Spine JO - Spine VL - 37 IS - 26 N2 - STUDY DESIGN: Case report. OBJECTIVE: To describe the use of posterior-only vertebral column resection and postoperative traction for spinal deformity associated with type-1 neurofibromatosis (NF1). SUMMARY OF BACKGROUND DATA: Vertebral deformity, namely, thoracic scoliosis, is the predominant orthopedic manifestation of NF1. Patients may present with debilitating pain and rarely, myelopathy. The commonly dystrophic nature of these deformities makes them particularly recalcitrant to surgical correction. Traditionally, circumferential arthrodesis via combined anterior and posterior approaches has been recommended. METHODS: Clinical and radiographical case review. RESULTS: A 14-year-old adolescent boy with NF1, severe cervicothoracic angular kyphosis, thoracic dislocation, and myelopathy presented status postmultiple anterior and posterior spinal fusions. The patient underwent posterior-only vertebral column resection after 6 weeks of halo-gravity traction. The surgery consisted of thoracic laminectomies, total corpectomies of T3 and T4, circumferential fusion, and posterior instrumentation from the occiput to T11. Autologous rib and iliac crest grafts were used as fusion substrate. Postoperatively, a halo vest was worn for 4 months to support the correction of his chin-on-chest deformity. The patient's neurological status returned to normal by 6 weeks postoperatively, and solid fusion was radiologically evident after 1 year. CONCLUSION: We think that posterior-only vertebral column resection represents a safe and efficacious but technically challenging option for the treatment of angular kyphotic spinal deformity and associated neurological deficit in patients with NF1. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/23044623/Posterior_vertebral_column_resection_for_the_treatment_of_dystrophic_kyphosis_associated_with_type_1_neurofibromatosis:_a_case_report_and_review_of_the_literature_ L2 - http://dx.doi.org/10.1097/BRS.0b013e3182770aa2 DB - PRIME DP - Unbound Medicine ER -