Clinical outcomes of anterior correction and reconstruction for neurofibromatosis-associated severe cervical kyphotic deformity
- 160 Downloads
To assess the clinical outcome of anterior correction and reconstruction for severe cervical kyphotic deformity due to neurofibromatosis type 1 (NF-1).
In this study, we reviewed a series of seven patients who underwent anterior procedures for correction of NF-1-associated cervical kyphotic deformity. After continuous preoperative skull traction, all patients received anterior corpectomy and fusion (ACCF), anterior discectomy and fusion (ACDF), or combined ACCF and ACDF for surgical correction and reconstruction. Pre- and postoperative local and global Cobb angles, correction rate, sagittal vertical axis (SVA), and T1-slope were assessed by X-ray. Japanese Orthopaedic Association (JOA) score, JOA recovery rate, visual analog scale (VAS), and Neck Disability Index (NDI) scores were recorded to assess the outcome.
Kyphosis was corrected successfully in all patients in terms of local and global Cobb angles (P < 0.05), with a correction rates of 83.1% (range, 66.0 to 115.5%) and 88.6% (range, 61.1 to 125.0%), respectively. JOA scores of patients were improved from preoperative 10.4 (range, 6 to 14) to postoperative 15.4 (range, 14 to 17), with a recovery rate as 77.6% (range, 66.7 to 100%). NDI scores were reduced from preoperative 25.1 (range, 13 to 35) to postoperative 8.7 (range, 5 to 12). VAS scores were reduced from preoperative 7.0 (range, 4 to 9) to postoperative 2.3 (range, 1 to 3).
This study has demonstrated that anterior correction and reconstruction is an alternative option for the treatment of NF-1-associated severe cervical kyphosis when deformity is localized, flexible, or fixed.
KeywordsJapanese Orthopaedic Association score Kyphosis Neurofibromatosis
This study is supported by a grant from National Natural Science Foundation of China (81501918).
No relevant financial activities outside the submitted work.
Compliance with ethical standards
The manuscript submitted does not contain information about medical device(s)/drug(s).
Conflict of interest
The authors declare that they have no conflict of interest.
Our research was approved by the ethics department of Changzheng Hospital, Shanghai. We have consensus with all participants. We also followed the Declaration of Helsinki and relevant policies in China.
- 4.Kim HJ, Piyaskulkaew C, Riew KD (2014) Anterior cervical osteotomy for fixed cervical deformities. Spine 39:1751–1757. https://doi.org/10.1097/BRS.0000000000000502
- 5.Tan LA, Riew KD (2017) Anterior cervical osteotomy: operative technique. Eur Spine J:1–9. https://doi.org/10.1007/s00586-017-5163-y
- 6.Shen X-L, Tian Y, Zhou X-H, et al. (2017) A radiographic analysis of cervical sagittal alignment in adolescent idiopathic cervical kyphosis. Clin Spine Surg 30:E560–E566. https://doi.org/10.1097/BSD.0000000000000257
- 7.Yonenobu K, Abumi K, Nagata K, et al. (2001) Interobserver and intraobserver reliability of the Japanese Orthopaedic Association scoring system for evaluation of cervical compression myelopathy. Spine 26:1890–1894Google Scholar
- 8.Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE (2014) Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain 155:2545–2550. https://doi.org/10.1016/j.pain.2014.09.014
- 9.Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manip Physiol Ther 14:409–415Google Scholar
- 11.Ferch RD, Shad A, Cadoux-Hudson TAD, Teddy PJ (2004) Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 100:13–19Google Scholar
- 16.Wang Z, Fu C, Leng J, et al. (2015) Treatment of dystrophic scoliosis in neurofibromatosis type 1 with one-stage posterior pedicle screw technique. Spine J 15:587–595. https://doi.org/10.1016/j.spinee.2014.10.014
- 20.Yoshihara H, Abumi K, Ito M, et al. (2013) Severe fixed cervical kyphosis treated with circumferential osteotomy and pedicle screw fixation using an anterior-posterior-anterior surgical sequence. World Neurosurg 80:654.e17–21. https://doi.org/10.1016/j.wneu.2013.01.023
- 25.Wu F, Zhang L, Liu Z, et al. (2012) Cervical neurofibromatosis with tetraplegia: management by cervical suspensory traction. Spine 37:E858–62. https://doi.org/10.1097/BRS.0b013e31824edd1c
- 28.Kokubun S, Ozawa H, Sakurai M, Ishii Y (1993) One-stage anterior and posterior correction of severe kyphosis of the cervical spine in neurofibromatosis. A Case Report Spine 18:2332–2335Google Scholar
- 30.Goffin J, Grob D (1999) Spondyloptosis of the cervical spine in neurofibromatosis. A Case Report. Spine 24:587–590Google Scholar