Deterioration of Operative Correction in Dystrophic Spinal Neurofibromatosis

Abstract

Spinal deformity in these patients tended to progress despite the achievement of spine arthrodesis in those with hyperkyphosis and short curves. The study shows that vertebral subluxation, disc wedging, and peripheral skeletal dystrophy are additional prognostic features that predict the progression of deformity after arthrodesis of the spine.

Spinal Reconstruction with Pedicle Screw-Based Instrumentation and rhBMP-2 in Patients with Neurofibromatosis and Severe Dural Ectasia and Spinal Deformity

“…Had there been pseudarthrosis, an anterior fusion to supplement the posterior procedure would have been considered. Although not seen in our patients, there are reports of curve progression even after achievement of solid fusion in patients with type-1 neurofibromatosis 16,46 , and for this reason, further follow-up is necessary.…”

“…Intrinsic pathologic conditions, such as osteomalacia and general mesodermal dysplasia, can also contribute to spinal instability in a more occult fashion 13 . Evidence of these processes on imaging studies includes rib penciling, meningoceles, expanded neural foramina, vertebral scalloping and wedging, and soft-tissue masses [15][16][17] . Clinical sequelae, ranging from simple back pain to decreased pulmonary function and quadriparesis, have been associated with the spinal manifestations of type-1 neurofibromatosis 18,19 .…”

Free vascularized bone graft in spinal surgery: indications and outcome in eight cases

“…During this period the grafted bone is weak and can fracture and there is a risk of nonunion [2,5,11,35]. This may result in deterioration of a deformity or even dislodgment of the graft [5,20,26,29,43].…”

Vascularized Fibula Strut Graft Used in Neurofibromatosis Type 1-Related Kyphosis: A Case of Almost Complete Reversal of Deformity-Induced Tetraparesis

“…The potential for graft displacement warrants major complication risk, for vascular and esophageal injuries. The presence of dystrophic features (not mentioned by the authors) increases the risk of kyphosis progression, and one would expect failure of a posterior approach if the patient is managed like a nondystrophic deformity 2,3,4,5…”