title: High-grade spondyloretrolisthesis in a 12-year-old girl with neurofibromatosis type 1:  a case report and literature review.
abstract: Neurofibromatosis (NF) type 1 is characterized by several skin, endocrine, central nervous system and musculoskeletal manifestations, spine deformities being the most common, affecting up to 64% of patients. Thoracic kyphoscoliosis is the most common deformity observed; however, high-grade spondylolisthesis and dural defects such as dural ectasia can also be found. The aim of this study is to describe a case of high-grade spondyloretrolisthesis in an NF-1 patient, associated with dural ectasia and extensive lumbar laminectomies, and to discuss our management and review the current literature on this controversial topic. A 12-year-old girl with NF-1 who had undergone extensive lumbar laminectomies in an outside facility presented to our emergency department complaining of back pain and lower limbs upper motor neuron symptoms. Image studies showed a high-grade lumbar spondyloretrolisthesis associated with dural ectasia. The first step of treatment was spine immobilization using a Boston brace. An anterior approach was used, and an L2 corporectomy was performed, using a Moss type cage between L1 and L3 with an instrumented arthrodesis and autologous bone graft for stabilization purposes. The second step planned was a posterior approach for arthrodesis and instrumentation, but after an extensive discussion with the parents and the patient, the parents did not agree to the procedure planned for the patient. A brace was used for 1 year while rehabilitation was performed. At the 1-year follow-up, there was a 70° kyphosis at the thoracolumbar junction but it was clinically stable, with an acceptable sagittal balance. Dural ectasia is not a common finding in children with NF-1; however, it should be identified as its presence may predispose to spine instability and as a consequence the development of a high-grade spondyloretrolisthesis. Even though a few cases have been reported, we believe that it is important to consider the option of a double approach to achieve a better correction in both planes and a good outcome. If an extensive laminectomy is involved, it is mandatory to perform a posterior fusion and instrumentation.
authors.affiliation: Pediatric Orthopaedic Division, Spine Unit, Doce de Octubre Hospital, Avda. De Córdoba s/n, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Martín-Fuentes
authors.forename: Juan
authors.initials: J
authors.lastname: Pretell-Mazzini
authors.forename: Angel
authors.initials: A
authors.lastname: Curto de la Mano
authors.forename: Rafael
authors.initials: R
authors.lastname: Viña-Fernández
mesh_terms: D001174:Arthrodesis / Q000379:methods / Q000534:rehabilitation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D009456:Neurofibromatosis 1 / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000534:rehabilitation; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods* / Q000534:rehabilitation; D013168:Spondylolisthesis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome