title: Simulated surgery for a patient with neurofibromatosis type-1 who had severe cervicothoracic kyphoscoliosis and an anomalous vertebral artery.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe the usefulness of simulated surgery for evaluation of a patient with neurofibromatosis type-1 (NF-1) who had severe cervicothoracic kyphoscoliosis and an anomalous vertebral artery (VA).
  
  
  BACKGROUND
  Several surgical procedures have been used in the treatment of cervicothoracic kyphoscoliosis associated with myelopathy in patients with NF-1. However, to our knowledge, there has been no report that describes a surgical procedure for NF-1 patients with anomalous VA at the cervical spine.
  
  
  METHODS
  A 45-year-old man with NF-1 developed cervical myelopathy. Preoperative examinations revealed severe cervicothoracic kyphoscoliosis, dystrophic changes of the cervical vertebrae, and the anomalous course of a VA and VA aneurysms. To assist in the preoperative planning and intraoperative navigation, we created 3-dimensional (3D) full-scale models of the patient's spine. Using a model, we performed a simulation of the planned surgery for spinal cord decompression with spinal fusion through both anterior and posterior approaches.
  
  
  RESULTS
  Through the simulation, we could evaluate the risk of VA injury at the process of corpectomy, and altered the surgical procedure for the spinal cord decompression with spinal fusion from a posterior approach and a bone graft alone from an anterior approach. We accomplished the surgery successfully without any neurovascular complications. After surgery, the patient experienced relief from myelopathy.
  
  
  CONCLUSIONS
  Preoperative surgical simulation using a 3D full-scale model was useful for improving the accuracy and safety of the surgery for cervicothoracic kyphoscoliosis with NF-1.
authors.affiliation: Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chuo-Ku, Chiba, Japan. masashiy@faculty.chiba-u.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fujiyoshi
authors.forename: Junko
authors.initials: J
authors.lastname: Kawabe
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Masao
authors.initials: M
authors.lastname: Koda
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003198:Computer Simulation; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009456:Neurofibromatosis 1 / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*