Li Ying, Luo Ming, Wang Wengang, Shen Mingkui, Xu Genzhong, Gao Jianbo, Xia Lei
Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, P. R. China.
Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, P. R. China.
World Neurosurg. 2017 Oct;106:898-904. doi: 10.1016/j.wneu.2017.07.064. Epub 2017 Jul 20.
To explore the prevalence and distribution of abnormal vertebral pedicles in scoliosis secondary to neurofibromatosis type 1 (NF1-S) and to compare the abnormal vertebrae pedicles between dystrophic and nondystrophic scoliosis.
Using computed tomography images, we carefully measured 2652 vertebral pedicles from 56 patients with NF1-S with dystrophic scoliosis and 22 patients with NF1-S with nondystrophic scoliosis. Pedicle morphology was classified as follows: type A, a cancellous channel of >4 mm; type B, a cancellous channel of 2 to 4 mm; type C, a cancellous channel of <2 mm with an entirely cortical channel of ≥2 mm; type D, a cortical channel of <2 mm; or type E, absent pedicle. Types B, C, D, and E were defined as abnormal.
The total prevalence of abnormal vertebral pedicles in patients with NF1-S was as high as 67%, with type B comprising 39%, type C comprising 22%, type D comprising 4%, and type E comprising 2%. A significantly greater rate of abnormal pedicles was found in dystrophic scoliosis compared with nondystrophic scoliosis (70% vs. 59%, P < 0.0001). The upper thoracic spine (87%) is the most concentrated region of abnormal pedicles compared with the lower thoracic (73%) and lumbar spine (34%).
There is a significantly high prevalence of abnormal pedicles in patients with NF1-S and an increased rate of abnormal pedicles in dystrophic scoliosis compared with nondystrophic ones. The described pedicle classification system could serve as an objective tool to guide preoperative assessment.
探讨1型神经纤维瘤病继发脊柱侧凸（NF1-S）中椎弓根异常的发生率及分布情况，并比较营养不良型和非营养不良型脊柱侧凸的椎弓根异常情况。
利用计算机断层扫描图像，我们仔细测量了56例患有营养不良型脊柱侧凸的NF1-S患者和22例患有非营养不良型脊柱侧凸的NF1-S患者的2652个椎弓根。椎弓根形态分类如下：A型，松质骨通道>4mm；B型，松质骨通道2至4mm；C型，松质骨通道<2mm且皮质骨通道≥2mm；D型，皮质骨通道<2mm；或E型，椎弓根缺如。B、C、D和E型被定义为异常。
NF1-S患者椎弓根异常的总发生率高达67%，其中B型占39%，C型占22%，D型占4%，E型占2%。与非营养不良型脊柱侧凸相比，营养不良型脊柱侧凸中椎弓根异常的发生率显著更高（70%对59%，P<0.0001）。与胸下段（73%）和腰椎（34%）相比，胸上段脊柱（87%）是椎弓根异常最集中的区域。
NF1-S患者椎弓根异常的发生率显著较高，与非营养不良型脊柱侧凸相比，营养不良型脊柱侧凸中椎弓根异常的发生率更高。所描述的椎弓根分类系统可作为指导术前评估的客观工具。
