Piazza Martin, Gupta Vivek P, Sponseller Paul D, Andras Lindsay M, Cheung Kenneth M C, Gomez Jaime A, Gupta Purnendu, Pahys Joshua M, Samdani Amer F, Hwang Steven W
Division of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Shriners Children's Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
Childs Nerv Syst. 2025 Aug 27;41(1):268. doi: 10.1007/s00381-025-06930-1.
Neurofibromatosis type 1 (NF-1) is a genetic disease with many clinical manifestations, including early onset scoliosis (EOS). There has been increasing interest in the use of growing rod constructs in these patients. Our study seeks to understand the complication rates of these procedures in patients with NF-1.
In this multicenter retrospective study, demographic data, radiologic measurements, type of surgical construct, complication information, and deformity outcomes were obtained. This information was then summarized using descriptive statistics in order to evaluate complication rates in the total cohort, between different types of curves, and between different surgical constructs.
Thirteen patients (8 males and 5 females) were included in the study, eight with dystrophic and five with non-dystrophic scoliosis. The mean preoperative major Cobb angle was 67.8° (median 75°, interquartile range [IQR] 53-83°). Four types of growth-friendly constructs were employed: seven vertical expandable prosthetic titanium rib (VEPTR), four traditional growing rod (TGR), one magnetically controlled growing rod (MCGR), and one Shilla. Major complications occurred in 11/13 patients (85%). Three patients (23%) had surgical site infections, nine (69%) had instrumentation complications, four (31%) had an unplanned surgical intervention other than for fusion, two (15%) had neurological complications, three (23%) had other complications, and seven (54%) required early surgical fusion. Two patients (15%) had additional complications after definitive fusion. The rate of overall complication rates was similar for dystrophic versus non-dystrophic curves (88% versus 80%).
There is a high rate of complications associated with growth-friendly constructs in patients with NF-1 dystrophic and non-dystrophic scoliosis. These complications must be weighed against the advantages of these procedures when deciding on the optimal procedure for patients with NF-1 EOS.
1型神经纤维瘤病（NF-1）是一种具有多种临床表现的遗传性疾病，包括早发性脊柱侧凸（EOS）。在这些患者中，使用生长棒结构的兴趣日益增加。我们的研究旨在了解NF-1患者这些手术的并发症发生率。
在这项多中心回顾性研究中，获取了人口统计学数据、放射学测量结果、手术结构类型、并发症信息和畸形结局。然后使用描述性统计对这些信息进行总结，以评估整个队列、不同类型曲线之间以及不同手术结构之间的并发症发生率。
13例患者（8例男性和5例女性）纳入研究，8例为营养不良性脊柱侧凸，5例为非营养不良性脊柱侧凸。术前主要Cobb角平均为67.8°（中位数75°，四分位间距[IQR]为53 - 83°）。采用了四种生长友好型结构：7例使用垂直可扩展人工钛肋（VEPTR），4例使用传统生长棒（TGR），1例使用磁控生长棒（MCGR），1例使用Shilla。11/13例患者（85%）发生了主要并发症。3例患者（23%）发生手术部位感染，9例（69%）发生器械相关并发症，4例（31%）进行了除融合外的计划外手术干预，2例（15%）发生神经并发症，3例（23%）发生其他并发症，7例（54%）需要早期手术融合。2例患者（15%）在确定性融合后出现额外并发症。营养不良性与非营养不良性曲线的总体并发症发生率相似（88%对80%）。
NF-1营养不良性和非营养不良性脊柱侧凸患者使用生长友好型结构的并发症发生率较高。在为NF-1 EOS患者确定最佳手术方案时，必须权衡这些并发症与这些手术的优势。
