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How to select the lowest instrumented vertebra in NF-1 non-dystrophic scoliosis

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Abstract

Purpose

To investigate lowest instrumented vertebra (LIV) selection strategy for neurofibromatosis type 1 (NF-1) non-dystrophic scoliosis.

Methods

Consecutive eligible subjects with NF-1 non-dystrophic scoliosis were included. All patients were followed up at least for 24 months. Enrolled patients with LIV in stable vertebra were divided into stable vertebra group (SV group), and the other patients with LIV above the stable vertebra were divided into above stable vertebra group (ASV group). Demographic data, operative data, preoperative and postoperative radiographic data, and clinical outcome were collected and analyzed.

Results

There were 14 patients in SV group (ten males and four females, mean age 13.9 ± 4.1 years) and 14 patients in ASV group (nine males and five females, mean age 12.9 ± 3.5 years). The mean follow-up period was 31.7 ± 17.4 months for patients in SV group and 33.6 ± 17.4 months for patients in ASV group, respectively. No significant differences were found in demographic data between two groups. The coronal Cobb angle, C7-CSVL, AVT, LIVDA, LIV tilt and SRS-22 questionnaire outcome significantly improved at the final follow-up in both groups. However, significantly higher loss of correction rate and increasement of LIVDA were found in ASV group. Two patients (14.3%) in ASV group but none in SV group suffered adding-on phenomenon.

Conclusions

Although patients in both SV and ASV groups obtained improved therapeutic efficacy at final follow-up, the radiographic and clinical outcome seemed more likely to deteriorate in ASV group after surgery. The stable vertebra should be recommended as LIV for NF-1 non-dystrophic scoliosis.

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References

  1. Tamura R (2021) Current understanding of neurofibromatosis type 1, 2, and schwannomatosis. Int J Mol Sci. https://doi.org/10.3390/ijms22115850

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yao Z, Li H, Zhang X, Li C, Qi X (2018) Incidence and risk factors for instrumentation-related complications after scoliosis surgery in pediatric patients with NF-1. Spine 43:1719–1724. https://doi.org/10.1097/BRS.0000000000002720

    Article  PubMed  Google Scholar 

  3. Vitale MG, Guha A, Skaggs DL (2002) Orthopaedic manifestations of neurofibromatosis in children: an update. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-200208000-00013

    Article  PubMed  Google Scholar 

  4. Toro G, Santoro C, Ambrosio D, Landi G, Scilipoti M, Moretti A, Paoletta M, Liguori S, Schiavone Panni A, Picariello S, Iolascon G (2021) Natural history of scoliosis in children with NF1: an observation study. Healthcare. https://doi.org/10.3390/healthcare9070881

    Article  PubMed  PubMed Central  Google Scholar 

  5. Park BJ, Hyun SJ, Wui SH, Jung JM, Kim KJ, Jahng TA (2020) Surgical outcomes and complications following all posterior approach for spinal deformity associated with neurofibromatosis type-1. J Korean Neurosurg Soc 63:738–746. https://doi.org/10.3340/jkns.2019.0218

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Shao X, Sui W, Deng Y, Yang J, Chen J, Yang J (2022) How to select the lowest instrumented vertebra in Lenke 5/6 adolescent idiopathic scoliosis patients with derotation technique. Eur Spine J 31:996–1005. https://doi.org/10.1007/s00586-021-07040-7

    Article  PubMed  Google Scholar 

  7. Kim HW, Weinstein SL (1997) Spine update. The management of scoliosis in neurofibromatosis. Spine 22:2770–2776. https://doi.org/10.1097/00007632-199712010-00014

    Article  CAS  PubMed  Google Scholar 

  8. Lyu Q, Zhou C, Song Y, Liu L, Wang L, Zhou Z (2017) Does spinal deformity correction of non-dystrophic scoliosis in neurofibromatosis type I with one-stage posterior pedicle screw technique produce outcomes similar to adolescent idiopathic scoliosis? Spine J 17:1850–1858. https://doi.org/10.1016/j.spinee.2017.06.011

    Article  PubMed  Google Scholar 

  9. Kurucan E, Bernstein DN, Thirukumaran C, Jain A, Menga EN, Rubery PT, Mesfin A (2018) National trends in spinal fusion surgery for neurofibromatosis. Spine Deform 6:712–718. https://doi.org/10.1016/j.jspd.2018.03.012

    Article  PubMed  Google Scholar 

  10. Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J (2014) Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1? Eur Spine J 23:1251–1257. https://doi.org/10.1007/s00586-014-3276-0

    Article  PubMed  Google Scholar 

  11. Rose PS, Lenke LG (2007) Classification of operative adolescent idiopathic scoliosis: treatment guidelines. Orthop Clin North Am 38:521–529. https://doi.org/10.1016/j.ocl.2007.06.001

    Article  PubMed  Google Scholar 

  12. Zhuang Q, Zhang J, Wang S, Yang Y, Lin G (2021) How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients? Spine J 21:141–149. https://doi.org/10.1016/j.spinee.2020.08.006

    Article  PubMed  Google Scholar 

  13. Shufflebarger HL (1989) Cotrel-Dubousset instrumentation in neurofibromatosis spinal problems. Clin Orthop Relat Res 24–28

  14. Crawford AH (1986) Neurofibromatosis in children. Acta Orthop Scand Suppl 218:1–60

    CAS  PubMed  Google Scholar 

  15. Yang N, Luo M, Zhao S, Wang W, Xia L (2020) Morphological differences between the pedicles in nondystrophic scoliosis secondary to neurofibromatosis type 1 and those in adolescent idiopathic scoliosis. World Neurosurg 144:e9–e14. https://doi.org/10.1016/j.wneu.2020.06.036

    Article  PubMed  Google Scholar 

  16. Tsirikos AI, Saifuddin A, Noordeen MH (2005) Spinal deformity in neurofibromatosis type-1: diagnosis and treatment. Eur Spine J 14:427–439. https://doi.org/10.1007/s00586-004-0829-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Crawford AH (1989) Pitfalls of spinal deformities associated with neurofibromatosis in children. Clin Orthop Relat Res 29–42

  18. Durrani AA, Crawford AH, Chouhdry SN, Saifuddin A, Morley TR (2000) Modulation of spinal deformities in patients with neurofibromatosis type 1. Spine 25:69–75. https://doi.org/10.1097/00007632-200001010-00013

    Article  CAS  PubMed  Google Scholar 

  19. Jett K, Friedman JM (2010) Clinical and genetic aspects of neurofibromatosis 1. Genet Med 12:1–11. https://doi.org/10.1097/GIM.0b013e3181bf15e3

    Article  PubMed  Google Scholar 

  20. Lykissas MG, Schorry EK, Crawford AH, Gaines S, Rieley M, Jain VV (2013) Does the presence of dystrophic features in patients with type 1 neurofibromatosis and spinal deformities increase the risk of surgery? Spine 38:1595–1601. https://doi.org/10.1097/BRS.0b013e31829a7779

    Article  PubMed  Google Scholar 

  21. Wang Z, Liu Y (2010) Research update and recent developments in the management of scoliosis in neurofibromatosis type 1. Orthopedics 33:335–341. https://doi.org/10.3928/01477447-20100329-20

    Article  CAS  PubMed  Google Scholar 

  22. Crawford AH, Parikh S, Schorry EK, Von Stein D (2007) The immature spine in type-1 neurofibromatosis. J Bone Jt Surg Am 89(Suppl 1):123–142. https://doi.org/10.2106/JBJS.F.00836

    Article  Google Scholar 

  23. Panjabi MM, Takata K, Goel V, Federico D, Oxland T, Duranceau J, Krag M (1991) Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine 16:888–901. https://doi.org/10.1097/00007632-199108000-00006

    Article  CAS  PubMed  Google Scholar 

  24. Liu Z, Qiu Y, Li Y, Zhao ZH, Wang B, Zhu F, Yu Y, Sun X, Zhu ZZ (2017) Clinical application of three-dimensional O-arm navigation system in treating patients with dystrophic scoliosis secondary to neurofibromatosis type I. Zhonghua Wai Ke Za Zhi 55:186–191. https://doi.org/10.3760/cma.j.issn.0529-5815.2017.03.005

    Article  CAS  PubMed  Google Scholar 

  25. Wang Z, Fu C, Leng J, Qu Z, Xu F, Liu Y (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

    Article  PubMed  Google Scholar 

  26. Deng A, Zhang HQ, Tang MX, Liu SH, Wang YX, Gao QL (2017) Posterior-only surgical correction of dystrophic scoliosis in 31 patients with neurofibromatosis Type 1 using the multiple anchor point method. J Neurosurg Pediatr 19:96–101. https://doi.org/10.3171/2016.7.PEDS16125

    Article  PubMed  Google Scholar 

  27. Marrache M, Suresh KV, Miller DJ, Hwang S, Schorry EK, Rios JJ, Sponseller PD (2021) Early-onset spinal deformity in neurofibromatosis type 1: natural history, treatment, and imaging surveillance. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.20.00285

    Article  PubMed  Google Scholar 

  28. Hu Z, Liu Z, Qiu Y, Xu L, Yan H, Zhu Z (2016) Morphological differences in the vertebrae of scoliosis secondary to neurofibromatosis type 1 with and without paraspinal neurofibromas. Spine 41:598–602. https://doi.org/10.1097/BRS.0000000000001455

    Article  PubMed  Google Scholar 

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Acknowledgements

We acknowledge all the participants in this study. In addition, Shao Xiexiang wants to express his special appreciation to Zhou Yu for her endless love, care and encouragement.

Funding

This work was supported by The Medical-engineering Cross Fund of Rising Star Plan in Shanghai Jiao Tong University (YG2021QN42) and National Natural Science Foundation of China (82072519).

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Author notes

  1. Xiexiang Shao, Tianyuan Zhang and Jingfan Yang these authors are co-first authors.

Authors and Affiliations

  1. Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University Shanghai Jiao Tong University, Shanghai, 200092, China

    Xiexiang Shao, Tianyuan Zhang, Jingfan Yang, Yaolong Deng, Junlin Yang & Wenyuan Sui

  2. Department of Spine Surgery, Sun Yat-Sen University Third Affiliated Hospital, Guangzhou, 510630, China

    Zifang Huang

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  1. Xiexiang Shao
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Contributions

XS: Designed the study, analyzed and interpreted the data, wrote and edited the manuscript. TZ: Designed the study, analyzed and interpreted the data, revised the manuscript. JY: Designed the study, analyzed and interpreted the data, revised the manuscript. YD: Designed the study, collected and analyzed the data, revised the manuscript. ZH: Analyzed and interpreted the data. JY: Designed the study, analyzed and interpreted the data, wrote and edited the manuscript. WS: Designed the study, analyzed and interpreted the data, wrote and edited the manuscript. XS, TZ and JY contributed equally and were considered as first author. JY and WS contributed equally and were considered as corresponding author.

Corresponding authors

Correspondence to Junlin Yang or Wenyuan Sui.

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Ethics approval

This study was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Shanghai, China, No.XHEC-D-2022–131).

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The authors declare that they have no conflict of interest.

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Shao, X., Zhang, T., Yang, J. et al. How to select the lowest instrumented vertebra in NF-1 non-dystrophic scoliosis. Eur Spine J 32, 1153–1160 (2023). https://doi.org/10.1007/s00586-023-07600-z

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