Rib head protrusion into the central canal in type 1 neurofibromatosis.
BACKGROUND
Intraspinal rib head dislocation is an important but under-recognized consequence of dystrophic scoliosis in patients with neurofibromatosis 1 (NF1).


OBJECTIVE
To present clinical and imaging findings of intraspinal rib head dislocation in NF1.


METHODS
We retrospectively reviewed clinical presentation, imaging, operative reports and post-operative courses in four NF1 patients with intraspinal rib head dislocation and dystrophic scoliosis. We also reviewed 17 cases from the English literature.


RESULTS
In each of our four cases of intraspinal rib head dislocation, a single rib head was dislocated on the convex apex of the curve, most often in the mid- to lower thoracic region. Cord compression occurred in half of these patients. Analysis of the literature yielded similar findings. Only three cases in the literature demonstrates the MRI appearance of this entity; most employ CT. All of our cases include both MRI and CT; we review the subtle findings on MRI.


CONCLUSIONS
Although intraspinal rib head dislocation is readily apparent on CT, sometimes MRI is the only cross-sectional imaging performed. It is essential that radiologists become familiar with this entity, as subtle findings have significant implications for surgical management.
Ton
Jimmy
J
Department of Radiology, University of California, Davis Medical Center and U.C. Davis Children's Hospital, Suite 3100, Sacramento, CA 95817, USA.
Stein-Wexler
Rebecca
R
Yen
Philip
P
Gupta
Munish
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications* / Q000175:diagnosis*; D012272:Ribs / Q000000981:diagnostic imaging* / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed