The effects of simple trauma on patients with cervical spine neurofibromatosis: Two case reports

Abstract

Von Recklinghausen's disease of the cervical spine is rare. Spinal deformities appear to occur only in peripheral neurofibromatosis as opposed to central neurofibromatosis, and such deformities include non-dystrophic and dystrophic changes. We describe two patients with neurofibromatosis of the cervical spine who were subjects of simple trauma, one of whom demonstrated dystrophic and the other nondystrophic changes. The first presented with acute upper cervical spine instability and subluxation, the second with cervical myelopathy. The purpose of this article is to heighten the physician's awareness that such patients have inherent pathology in the cervical spine such that simple trauma can have serious neurological consequences.

Successfully Treated Traumatic Dislocation of a Thoracic Vertebra Caused by Minor Trauma in a Patient with Neurofibromatosis Type I A Case Report and Literature Review

“…Reported cases of NF-1 with spinal cord injury caused by minor trauma are summarized in Table 1 . 3 , 6 , 10 , 11) Despite a meticulous review of the literature, only seven cases, including the present case, were found. Considering the expected incidence of NF-1 with spinal deformity, this small number is said to be incredible.…”

“…Spinal deformity is the most commonly observed, but its incidence was reportedly ranged from 2% to 69% of NF-1 patients. 1 , 3 , 5) Akbarnia et al 1) believe that 10% is representative of the true prevalence of spinal deformity. Recent studies using MRI suggested a much higher incidence.…”

“…Spinal deformities are usually classified into non-dystrophic and dystrophic types based on the absence or presence of skeletal deformities on plain radiographic evaluation. 1 – 3) Dystrophic features include vertebral scalloping (posterior, lateral, or anterior), rib penciling or spindling of the transverse processes, wedging of one or more vertebral bodies, a short curve with significant apical rotation, foraminal enlargement, defective pedicles, and associated paraspinal masses. 1 , 2 , 5 , 8 – 10) These changes often occur in sectioned vertebral columns.…”

“…Spinal decompensation in neurofibromatosis is generally classified into non-dystrophic and dystrophic types based on the absence or presence of skeletal deformities during plain radiographic evaluation. 1 – 3) Dystrophic changes may cause destabilization of the vertebrae, occasionally leading to spontaneous subluxation or dislocation 4 , 9) and indicating vulnerability to extrinsic forces, subsequently leading to spinal cord injury. 4 , 5) However, a small number of spinal cord injuries has been reported to be caused by minor trauma in patients with NF-I.…”

“… 4 , 5) However, a small number of spinal cord injuries has been reported to be caused by minor trauma in patients with NF-I. 3 , 6 , 10 , 11)…”