Simulated surgery for a patient with neurofibromatosis type-1 who had severe cervicothoracic kyphoscoliosis and an anomalous vertebral artery.
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.
Yamazaki
Masashi
M
Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chuo-Ku, Chiba, Japan. masashiy@faculty.chiba-u.jp
Okawa
Akihiko
A
Fujiyoshi
Takayuki
T
Kawabe
Junko
J
Yamauchi
Tomonori
T
Furuya
Takeo
T
Takaso
Masashi
M
Koda
Masao
M
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*