Wang Zhenyu, Fu Changfeng, Leng Jiali, Qu Zhigang, Xu Feng, Liu Yi
Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
Orthopedics Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
Spine J. 2015 Apr 1;15(4):587-95. doi: 10.1016/j.spinee.2014.10.014. Epub 2014 Oct 22.
Corrective surgery for dystrophic scoliosis in neurofibromatosis Type 1 (NF-1) is challenging. There are various surgical methods, all with unsatisfactory outcomes.
The purpose of the study was to evaluate the clinical outcomes of the treatment of dystrophic scoliosis in NF-1 with one-stage posterior pedicle screw approach.
This is a retrospective clinical study.
Sixteen patients with dystrophic scoliosis in NF-1 underwent one-stage posterior surgery with pedicle screw system.
We used preoperative and postoperative whole-spine radiographs to determine coronal and sagittal Cobb angles (curve correction); distance between apex vertebra and central sacral vertical line (DAC), pelvic obliquity, and shoulder tilt (coronal balance improvement); and sagittal vertical axis and pelvic tilt angle (sagittal balance improvement). We assessed the fusion rate using fusion segment computed tomography scan.
Patients underwent surgery with or without osteotomy according to spinal flexibility. Fusion segment selection method of fusion segments selection which mean fusing from one or two levels proximal to upper end vertebra to one or two levels distal to the lower end vertebra (EV+1 or 2) or stable vertebrae fusion. There were no study-specific conflict of interest-associated biases.
The average follow-up time was 40.9 months. Mean scoliosis and kyphosis improved from 83.2° to 27.6° and 58.5° to 26.8°, respectively; at the last follow-up, it was 30.4° and 27.4°, respectively. Mean DAC, pelvic obliquity, and shoulder tilt improved from 53.0 to 23.9, 8.1 to 4.9, and 9.8 to 7.5 mm, respectively. Sagittal vertical axis and pelvic tilt angle improved from -5.8 to 1.6 mm and 17.9° to -5.8°, respectively. During follow-up, mean coronal and sagittal correction losses were 2.8° and 0.7°, respectively. Two EV+1 or 2 patients had decompensation. No pseudoarthrosis was identified.
The one-stage posterior pedicle screw approach is safe and effective in the treatment of dystrophic scoliosis in NF-1. Posterior vertebral column resection is recommended if flexibility is less than 35%. Stable vertebrae fusing is recommended.
1型神经纤维瘤病（NF-1）中营养不良性脊柱侧凸的矫正手术具有挑战性。有多种手术方法，但效果均不尽人意。
本研究旨在评估一期后路椎弓根螺钉入路治疗NF-1中营养不良性脊柱侧凸的临床疗效。
这是一项回顾性临床研究。
16例NF-1中营养不良性脊柱侧凸患者接受了一期后路椎弓根螺钉系统手术。
我们使用术前和术后全脊柱X线片来确定冠状面和矢状面Cobb角（曲线矫正）；顶椎与骶骨中央垂直线之间的距离（DAC）、骨盆倾斜度和肩部倾斜度（冠状面平衡改善）；以及矢状垂直轴和骨盆倾斜角（矢状面平衡改善）。我们使用融合节段计算机断层扫描评估融合率。
根据脊柱柔韧性，患者接受有或无截骨术的手术。融合节段选择方法为从上端椎近端的一个或两个节段融合至下端椎远端的一个或两个节段（EV + 1或2）或稳定椎体融合。本研究不存在与利益冲突相关的特定偏倚。
平均随访时间为40.9个月。平均脊柱侧凸和后凸分别从83.2°改善至2留6°和58.5°改善至26.8°；在最后一次随访时，分别为30.4°和27.4°。平均DAC、骨盆倾斜度和肩部倾斜度分别从53.0改善至23.9、8.1改善至4.9和9.8改善至7.5mm。矢状垂直轴和骨盆倾斜角分别从-5.8改善至1.6mm和17.9°改善至-5.8°。随访期间，平均冠状面和矢状面矫正丢失分别为2.8°和0.7°。两名EV + 1或2患者出现失代偿。未发现假关节形成。
一期后路椎弓根螺钉入路治疗NF-1中营养不良性脊柱侧凸安全有效。如果柔韧性小于35%，建议行后路脊柱切除术。建议进行稳定椎体融合。
