Functional and Radiological Outcomes of All-Posterior Surgical Correction of Dystrophic Curves in Patients with Neurofibromatosis Type 1.

IF 2.3 Q2 ORTHOPEDICS
Asian Spine Journal Pub Date : 2024-04-01 Epub Date: 2024-03-08 DOI:10.31616/asj.2023.0294
Ajoy Prasad Shetty, Jalaj Meena, Chandhan Murugan, Rounak Milton, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran
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Abstract

Study design: A retrospective cohort study.

Purpose: To determine outcomes following all-posterior surgery using computed tomography navigation, hybrid stabilization, and multiple anchor point techniques in patients with neurofibromatosis type 1 (NF-1) and dystrophic scoliosis.

Overview of literature: Previous studies favored antero-posterior fusion as the most reliable method; however, approaching the spine anteriorly was fraught with significant complications. With the advent of computer assisted navigation and multiple anchor point method, posterior only approach is reporting successful outcomes.

Methods: This study included patients who underwent all-posterior surgical deformity correction for dystrophic NF-1 curves. Coronal and sagittal Cobbs angles, apical rotation, and the presence of dystrophic features were evaluated before surgery. Postoperatively, sagittal, coronal, and axial correction, implant position, and implant densities were evaluated. The decline in curve correction and implant-related complications were evaluated at follow-up. Clinical outcomes were evaluated using the Scoliosis Research Society-22 revised index.

Results: This study involved 50 patients with a mean age of 13.6 years and a mean follow-up duration of 5.52 years. With a mean coronal flexibility of 18.7%, the mean apical vertebral rotation (AVR), preoperative coronal Cobb angle, and sagittal kyphosis were 27.4°, 64.01°, and 47.70°, respectively. The postoperative mean coronal Cobb angle was 30.17° (p <0.05), and the sagittal kyphosis angle was 25.4° (p <0.05). The average AVR correction rate was 41.3%. The correction remained significant at the final mean follow-up, with a coronal Cobb angle of 34.14° and sagittal kyphosis of 25.02° (p <0.05). The average implant density was 1.41, with 46% of patients having a high implant density (HID). The HID had a markedly higher mean curve correction (29.30° vs. 38.05°, p <0.05) and a lower mean loss of correction (5.7° vs. 3.8°, p <0.05).

Conclusions: Utilizing computer-assisted navigation, hybrid instrumentation, and multiple anchor point technique and attaining high implant densities, this study demonstrates successful outcomes following posterior-only surgical correction of dystrophic scoliosis in patients with NF-1.

神经纤维瘤病 1 型患者萎缩性弧形全胸廓手术矫正的功能和放射学效果。
研究设计目的:确定神经纤维瘤病1型(NF-1)和营养不良性脊柱侧凸患者使用计算机断层扫描导航、混合稳定和多锚点技术进行全脊柱后路手术后的疗效:以往的研究认为,前路-后路融合是最可靠的方法;然而,前路接近脊柱充满了严重的并发症。随着计算机辅助导航和多锚点方法的出现,仅后路方法也取得了成功:本研究纳入了接受全后路手术畸形矫正的营养不良型 NF-1 脊柱患者。术前对患者的冠状面和矢状面Cobbs角、心尖旋转以及是否存在营养不良特征进行了评估。术后对矢状、冠状和轴向矫正、植入体位置和植入体密度进行了评估。随访时对曲线矫正的下降和植入物相关并发症进行评估。临床结果采用脊柱侧凸研究协会-22修订指数进行评估:这项研究涉及 50 名患者,平均年龄为 13.6 岁,平均随访时间为 5.52 年。平均冠状面柔韧性为18.7%,平均椎体顶端旋转(AVR)、术前冠状面Cobb角和矢状面脊柱侧弯分别为27.4°、64.01°和47.70°。术后冠状面 Cobb 角的平均值为 30.17°(P 结论):本研究利用计算机辅助导航、混合器械、多锚点技术和高植入物密度,证明了仅通过后路手术矫正 NF-1 患者营养不良性脊柱侧凸的成功结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
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