Effect of higher implant density on curve correction in dystrophic thoracic scoliosis secondary to neurofibromatosis Type 1

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The aim of this study was to investigate how implant density affects radiographic results and clinical outcomes in patients with dystrophic scoliosis secondary to neurofibromatosis Type 1 (NF1).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 41 patients with dystrophic scoliosis secondary to NF1 who underwent 1-stage posterior correction between June 2011 and December 2013 were included. General information about patients was recorded, as were preoperative and postoperative scores from Scoliosis Research Society (SRS)–22 questionnaires. Pearson correlation analysis was used to analyze the associations among implant density, coronal Cobb angle correction rate and correction loss at last follow-up, change of sagittal curve, and apical vertebral translation. Patients were then divided into 2 groups: those with low-density and those with high-density implants. Independent-sample t-tests were used to compare demographic data, radiographic findings, and clinical outcomes before surgery and at last follow-up between the groups.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Significant correlations were found between the implant density and the coronal correction rate of the main curve (r = 0.505, p &lt; 0.01) and the coronal correction loss at final follow-up (r = −0.379, p = 0.015). There was no significant correlation between implant density and change of sagittal profile (p = 0.662) or apical vertebral translation (p = 0.062). The SRS-22 scores improved in the appearance, activity, and mental health domains within both groups, but there was no difference between the groups in any of the SRS-22 domains at final follow-up (p &gt; 0.05 for all).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Although no significant differences between the high- and low-density groups were found in any of the SRS-22 domains at final follow-up, higher implant density was correlated with superior coronal correction and less postoperative correction loss in patients with dystrophic NF1-associated scoliosis.</jats:p></jats:sec>

Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

“…The clinical outcome of dystrophic scoliosis patients treated with posterior-only fusion by using hooks and rods demonstrated that the pseudarthrosis rate was high and curve progression was common [17]. Recently, some good results of posterior only fusion surgeries in NF-1 patients with dystrophic scoliosis have been reported [9,10,19]. In this study, we reported our results about the posterior only fusion procedure in NF-1 patients with EOS.…”

“…In addition, it has been found that higher density of pedicle screw placement can help to improve the postoperative correction rate of EOS in NF-1patients [10,19]. We can only perform regular fluoroscopy due to the lack of O-arm at the early stage of our study, which made it difficult to place the pedicle screws.…”

“…Recently, the posterior only instrument fusion was reported to be used to treat dystrophic scoliosis in NF-1 patients because challenges for the anterior approach caused by the extensive plexiform tumors could be avoided by using posterior approach and a good short-term result from posterior approach has been reported [9,10]. In Li and his colleagues' study, the posterior only approach demonstrated a good short-term result to treat early-onset scoliosis (EOS) in a group of NF-1 patients with an average age of 13 (the youngest patient was 8 years old), but the number of included patients were not addressed [10]. However, it is rarely reported whether posterior spinal fusion will achieve a good mid-long-term result in patients at young age (age < 10Yrs) [11].…”

Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

“…17Recently, some good results of posterior only fusion surgeries in NF-1 patients with dystrophic scoliosis have been reported. (9,10,19) In this study, we reported our results about the posterior only fusion procedure in NF-1 patients with EOS.…”

Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

“…Recently, the posterior only instrument fusion was reported to be used to treat dystrophic scoliosis in NF-1 patients because challenges for the anterior approach caused by the extensive plexiform tumors could be avoided by using posterior approach and a good short-term result from posterior approach has been reported. (9, 10) In Li and his colleagues' study, the posterior only approach demonstrated a good short-term result to treat early-onset scoliosis (EOS) in a group of NF-1 patients with an average age of 13 (the youngest patient was 8 years old), but the number of included patients were not addressed (10). However, it is rarely reported whether posterior spinal fusion will achieve a good midlong-term result in patients at young age (age<10Yrs) (11).…”