Posterior-only spinal fusion without rib head resection for treating type I neurofibromatosis with intra-canal rib head dislocation.
OBJECTIVE
Patients with Type I neurofibromatosis scoliosis with intra-canal rib head protrusion are extremely rare. Current knowledge regarding the diagnosis and treatment for this situation are insufficient. The purpose of this study is to share our experience in the diagnosis and surgical treatments for such unique deformities.


METHODS
Six patients with Type I neurofibromatosis scoliosis with rib head dislocation into the spinal canal were diagnosed at our institution. Posterior instrumentation and spinal fusion without intra-canal rib head resection via a posterior-only approach was performed for deformity correction and rib head extraction. The efficacy and outcomes of the surgery were evaluated by measurements before, immediately and 24 months after the surgery using the following parameters: coronal spinal Cobb angle, apex rotation and kyphosis of the spine and the intra-canal rib head position. Post-operative complications, surgery time and blood loss were also evaluated.


RESULTS
Patients were followed up for at least 24 months post-operatively. The three dimensional spinal deformity was significantly improved and the intra-canal rib head was significantly extracted from the canal immediately after the surgery. At follow-up 24 months after surgery, solid fusions were achieved along the fusion segments, and the deformity corrections and rib head positions were well maintained. There were no surgery-related complications any time after the surgery.


CONCLUSIONS
Systematic examinations are needed to identify patients with Type I neurofibromatosis scoliosis with rib head dislocation into the canal who can be treated by posterior-only spinal fusion without rib head resection.
Orthopedic Department of Southwest Hospital, Third Military Medical University, Chongqing, China.
Dong
D
Sun
Orthopedic Department of Southwest Hospital, Third Military Medical University, Chongqing, China.
Fei
F
Dai
Orthopedic Department of Southwest Hospital, Third Military Medical University, Chongqing, China.
Yao Yao
YY
Liu
Orthopedic Department of Southwest Hospital, Third Military Medical University, Chongqing, China.
Jian-Zhong
JZ
Xu
D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009456:Neurofibromatosis 1 / Q000000981:diagnostic imaging / Q000601:surgery*; D015588:Observer Variation; D061646:Operative Time; D012272:Ribs / Q000000981:diagnostic imaging / Q000601:surgery*; D012399:Rotation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome