Boğa Zeki, Olguner Semih Kıvanç, Türkmen Tolga, Kara Ümit, Arslan Ali, Özer Mehmet, Çınkı Ahmet Hamit, Gezercan Yurdal
Department of Neurosurgery, Adana City Hospital, Adana, Turkey.
Department of Neurosurgery, Dörtyol State Hospital, Hatay, Turkey.
JB JS Open Access. 2025 May 8;10(2). doi: 10.2106/JBJS.OA.24.00252. eCollection 2025 Apr-Jun.
Neurofibromatosis type 1 (NF-1) can cause severe kyphosis in the cervical vertebrae. There is no consensus on the optimal surgical treatment for this rare condition, although long-segment fixation and combined approaches are generally preferred. To our knowledge, this study is the first to report the clinical outcomes of patients with NF-related cervical kyphosis who underwent stand-alone posterior pedicle fixation surgery.
The outcomes of 14 patients who underwent surgery using the pedicle screw were retrospectively examined between 2015 and 2022. Only patients with at least 2 years of follow-up were included. For each patient, the following parameters were recorded and evaluated at 1 month postoperatively and at the end of the follow-up period: cervical lordosis (CL), local kyphosis angle (LKA), T1 slope, cervical sagittal vertical axis, visual analog score for neck pain, modified Japanese Orthopedic Association score, and Neck Disability Index. Complications, surgical duration, blood loss, levels of instrumentation, and length of hospital stay were also recorded.
In terms of radiographic parameters, all patients achieved lordosis, with the cervical LKA improving from an average of 76.7° preoperatively to an average of 20.4° in the early postoperative period. At the 2-year follow-up, the postoperative CL significantly improved compared with preoperative values (p < 0.001) with only approximately 4° correction loss. Moreover, by the end of the follow-up, all postoperative symptoms showed improvement compared with the preoperative symptoms. The average surgical duration was 211.86 ± 49.83 min. During the follow-up, junctional kyphosis was observed in 4 patients all of whom required revision surgery. C5 palsy was detected in 3 patients. Infection-related complications occurred in 6 patients, with wound infection in only 1 patient.
Cervical pedicle screw fixation is an effective treatment for NF-1-related cervical kyphosis. Although this technique is considered difficult and dangerous to apply by several spine surgeons, it exerts a positive effect on clinical improvement and provides optimal correction.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
1型神经纤维瘤病（NF-1）可导致严重的颈椎后凸。对于这种罕见病症的最佳手术治疗方法尚无共识，尽管通常更倾向于采用长节段固定和联合手术方式。据我们所知，本研究是首例报告接受单纯后路椎弓根固定手术的NF相关颈椎后凸患者的临床结局。
回顾性分析2015年至2022年间14例行椎弓根螺钉手术患者的结局。仅纳入随访至少2年的患者。对每位患者，在术后1个月和随访期末记录并评估以下参数：颈椎前凸（CL）、局部后凸角（LKA）、T1斜率、颈椎矢状垂直轴、颈部疼痛视觉模拟评分、改良日本骨科协会评分和颈部功能障碍指数。还记录并发症、手术时长、失血量、内固定节段数和住院时间。
在影像学参数方面，所有患者均实现了前凸，颈椎LKA从术前平均76.7°改善至术后早期平均20.4°。在2年随访时，术后CL与术前值相比显著改善（p < 0.001），仅约4°的矫正丢失。此外，到随访结束时，所有术后症状与术前症状相比均有改善。平均手术时长为211.86 ± 49.83分钟。随访期间，4例患者出现交界性后凸，均需翻修手术。3例患者检测到C5麻痹。6例患者发生感染相关并发症，仅1例患者出现伤口感染。
颈椎椎弓根螺钉固定是治疗NF-1相关颈椎后凸的有效方法。尽管该技术被一些脊柱外科医生认为应用困难且危险，但它对临床改善有积极作用并提供了最佳矫正。
治疗性IV级。有关证据水平完整描述，请参阅作者指南。
