title: Treatment of dystrophic scoliosis in neurofibromatosis Type 1 with one-stage posterior pedicle screw technique.
abstract: BACKGROUND
  Corrective surgery for dystrophic scoliosis in neurofibromatosis Type 1 (NF-1) is challenging. There are various surgical methods, all with unsatisfactory outcomes.
  
  
  OBJECTIVE
  The purpose of the study was to evaluate the clinical outcomes of the treatment of dystrophic scoliosis in NF-1 with one-stage posterior pedicle screw approach.
  
  
  METHODS
  This is a retrospective clinical study.
  
  
  METHODS
  Sixteen patients with dystrophic scoliosis in NF-1 underwent one-stage posterior surgery with pedicle screw system.
  
  
  METHODS
  We used preoperative and postoperative whole-spine radiographs to determine coronal and sagittal Cobb angles (curve correction); distance between apex vertebra and central sacral vertical line (DAC), pelvic obliquity, and shoulder tilt (coronal balance improvement); and sagittal vertical axis and pelvic tilt angle (sagittal balance improvement). We assessed the fusion rate using fusion segment computed tomography scan.
  
  
  METHODS
  Patients underwent surgery with or without osteotomy according to spinal flexibility. Fusion segment selection method of fusion segments selection which mean fusing from one or two levels proximal to upper end vertebra to one or two levels distal to the lower end vertebra (EV+1 or 2) or stable vertebrae fusion. There were no study-specific conflict of interest-associated biases.
  
  
  RESULTS
  The average follow-up time was 40.9 months. Mean scoliosis and kyphosis improved from 83.2° to 27.6° and 58.5° to 26.8°, respectively; at the last follow-up, it was 30.4° and 27.4°, respectively. Mean DAC, pelvic obliquity, and shoulder tilt improved from 53.0 to 23.9, 8.1 to 4.9, and 9.8 to 7.5 mm, respectively. Sagittal vertical axis and pelvic tilt angle improved from -5.8 to 1.6 mm and 17.9° to -5.8°, respectively. During follow-up, mean coronal and sagittal correction losses were 2.8° and 0.7°, respectively. Two EV+1 or 2 patients had decompensation. No pseudoarthrosis was identified.
  
  
  CONCLUSIONS
  The one-stage posterior pedicle screw approach is safe and effective in the treatment of dystrophic scoliosis in NF-1. Posterior vertebral column resection is recommended if flexibility is less than 35%. Stable vertebrae fusing is recommended.
authors.affiliation: Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
authors.forename: Changfeng
authors.initials: C
authors.lastname: Fu
authors.affiliation: Orthopedics Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
authors.forename: Jiali
authors.initials: J
authors.lastname: Leng
authors.affiliation: Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Qu
authors.affiliation: Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China. Electronic address: successwzy@sohu.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications*; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*
keywords: Dystrophic scoliosis; Neurofibromatosis; One stage; Pedicle screw techniques; Posterior instrumentation and fusion; Posterior vetebral column resection