Non-idiopathic spinal deformity with rotatory subluxation: how to prevent intra-operative neurologic complications?

English Keywords:Neurofibromatosis type 1  Early onset scoliosis  Dystrophic  Dual growing rod technique  Fusionless technique  Complications

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of dual growing rod(GR) technique in the treatment of early onset dystrophic scoliosis(EOS) with neurofibromatosis type 1(NF-1). Methods: Eight patients (2 males, 6 females) receiving dual GR technique for EOS with NF-1 in our hospital, from May 2010 to March 2014, were retrospectively reviewed. The average age was 7.4±1.4 years old(range, 5-9 years). The medical records of all these patients were reviewed. The parameters included age at initial surgery and the final follow-up, number and frequency of lengthening, and complications. Radiographic evaluation included scoliosis Cobb angle, thoracic kyphosis, lumbar lordosis, trunk shift, length of T1-S1, and Campbell′s space available for lung ratio(SAL). Results: The mean follow-up was 36.9±13.5(range, 24-64) months. A total of 41 surgeries were performed, and 33 of them were lengthening procedures, with an average of 4.1 lengthenings for each patient. The mean scoliosis Cobb angle improved from 75.4°±26.4° to 31.6°±10.8° after initial surgery and was 30.9°±11.4° at the final follow-up. The average growth of T1-S1 length was 1.66±0.43cm/y. The SAL increased from 0.92±0.10 to 0.99±0.02 after initial surgery and was 1.00±0.05 at the final follow-up. Five complications occurred in 3 patients and most of them were implant-related (4 complications). No infection and nervous system complications occurred. Conclusions: The dual GR technique is safe and effective for patients with early onset dystrophic scoliosis secondary to NF-1. It maintains correction achieved at initial surgery while allowing the growth of the spine and thoracic cage, without significant increase of total complication rate.