Pseudarthrosis Repair Using Autologous Cultured Osteoblasts in Complex Type-1 Neurofibromatosis Spinal Deformity: A Case Report and Review of the Literature.
METHODS
A case report and literature review.


OBJECTIVE
To report a late dislocation of the vertebra caused by progressive dural ectasia combined with type-1 neurofibromatosis (NF-1) and the clinical results of pseudarthrosis repairs using autologous cultured osteoblasts.


BACKGROUND
NF-1 is a well-known genetic disorder that is commonly characterized by spinal deformities including kyphoscoliosis. Late dislocation of the vertebra resulting from progressive dural ectasia after surgical correction of NF-1 scoliosis is a very rare occurrence, and pseudarthrosis frequently develops after surgical intervention for this complex spinal deformity.


METHODS
A 32-year-old female patient with NF-1 scoliosis underwent surgical correction with posterior instrumented fusion. Seventeen years later, dislocation of the lumbar spine with implant failure resulting from massive progressive dural ectasia was observed. She underwent anterior interbody fusion three times and posterior instrumented fusion four times for pseudarthrosis followed by surgical deformity correction. For the last operation, autologous cultured osteoblasts were used as a therapeutic approach to repair the pseudarthrosis, and a three-dimensional printing technique was used to understand the surgical anatomy of the dislocated lumbar spine in detail.


RESULTS
After the final operation, bone union was achieved and confirmed by clinical and radiological examination.


CONCLUSIONS
Spine surgeons should be knowledgeable about the possibility of late destabilization of the spine, due to pulsatile dural ectasia, and a high rate of pseudarthrosis in neurofibromatosis. Autologous cultured osteoblasts may prove to be a modality that can be applied pseudarthrosis repair to treat complex spinal deformity.


METHODS
5.
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Young-Hoon
YH
Kim
Genriech N
GN
Reoyan
Kee-Yong
KY
Ha
Chul-Kyu
CK
Kim
D000328:Adult; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D009456:Neurofibromatosis 1 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010006:Osteoblasts / Q000166:cytology*; D011542:Pseudarthrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome