J Korean Orthop Assoc.  2007 Dec;42(6):822-827. 10.4055/jkoa.2007.42.6.822.

Spontaneous Vertebral Column Dislocation in Neurofibromatosis: A Case Report

• Kim KT
• Lee SH
• Suk KS
• Lee JH
• Seo EM
• Jeong BO

• KMID: 1947791
• DOI: http://doi.org/10.4055/jkoa.2007.42.6.822

Abstract

The dystrophic type of neurofibromatosis is a well-known bizarre deformity of the spine. There has been little literature about spontaneous vertebral column dislocation in the thoracic spine with progressive neurological symptoms. The authors present a case of thoracic spine dislocation vertically and transversely with intact posterior elements. A 35-year-old woman had stooping and back pain for five years. She developed motor weakness of both lower extremities three months ago. Plain X-ray and three-dimensional CT scans showed dislocation between T5 and T6 vertebrae, that were which was translated transversely and vertically with severe resorption of vertebral pedicles of T5 and T6. After skeletal traction, motor weakness was improved. And we performed two-staged anterior and posterior fusion to stabilize severe kyphoscoliosis. The patient was improved neurologically with free ambulation state at 24-month follow-up. Combined anterior and posterior fusion was an effective method for the treatment spontaneous vertebral column dislocation in the thoracic spine with progressive neurological symptoms.

Keyword

Neurofibromatosis; Spontaneous vertebral column dislocation; Dystrophic kyphoscoliosis

MeSH Terms

Adult
Back Pain
Congenital Abnormalities
Dislocations*
Female
Follow-Up Studies
Humans
Lower Extremity
Neurofibromatoses*
Neurofibromatosis 1
Spine*
Tomography, X-Ray Computed
Traction
Walking

Figure

• 

  Fig. 1 The anteroposterior and lateral radiograph shows a thoracic kyphoscoliosis and 95 degrees of segmental kyphosis involving T4 through T7.

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  Fig. 2 Three dimensional CT scan shows a complete dislocation of the fourth and fifth vertebrae on the sixth and seventh anterolaterally, with the body of the T4 and 5 situated immediately anterior and right side to that of T6 and 7. All the posterior structures are preserved with smooth scoliotic curve.

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  Fig. 3 Two consecutive axial CT images showing severe destruction and resorption of vertebral pedicles of T5 and 7.

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  Fig. 4 Two consecutive coronal MR images show the continuity of spinal canal and sparing the spinal cord with dural ectasia around the deformity.

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  Fig. 5 The anteroposterior and lateral radiograph taken after the first procedure (posterior pedicle screw instrumentation with fusion from T2 to T12).

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