J Minim Invasive Spine Surg Tech.  2024 Jul;9(Suppl 2):S172-S184. 10.21182/jmisst.2024.01235.

Efficacy and Surgical Outcomes of Posterior Apical Spinal Osteotomy in Severe Thoracic/Thoracolumbar/Lumbar Kyphoscoliosis in Dystrophic Curves of Neurofibromatosis Type 1

• Khandge AV
• Patel J
• Nair VV
• Patel J
• Kundnani V
• Chodavadiya S

• KMID: 2562264
• DOI: http://doi.org/10.21182/jmisst.2024.01235

Abstract

Objective
Kyphoscoliosis is the most common deformity seen in patients with neurofibromatosis type 1 (NF1), occurring in 10%–60% of cases. These dystrophic curves often exhibit severe deformities that require surgical intervention. Various procedures have been evaluated and studied; however, there is no consensus, and these are also associated with a higher rate of morbidity. Therefore, this study aimed to evaluate the clinical and radiological outcomes of apical spinal osteotomy (ASO) in NF1 patients with dystrophic curves who exhibited thoracic, thoracolumbar, or lumbar kyphoscoliosis.
Methods
We conducted a retrospective analysis of prospectively collected data involving 21 children with dystrophic NF1 curves who underwent ASO at a single tertiary care center from November 2009 to June 2017. The efficacy of ASO for correcting coronal and sagittal deformities was assessed. Clinical outcomes (visual analogue scale [VAS], Oswestry Disability Index [ODI], and Frankel grade) and radiological outcomes (Cobb angle correction, fusion, and complications) were evaluated.
Results
The study included 21 patients (11 males, 10 females) with a mean age at surgery of 9.33 years. The mean kyphotic Cobb angle improved significantly from 98.33° to 36.52°. The mean sagittal vertical axis also improved significantly from 7.40 cm to 4.21 cm, along with significant improvements in VAS and ODI scores.
Conclusion
This study describes a technique using a posterior approach for single-level ASO in the treatment of severe dystrophic NF1 curves. The technique can be effective in children with mild to moderate curves, yielding good clinicoradiological outcomes and satisfactory correction rates.

Keyword

Posterior apical spinal osteotomy; Kyphoscoliosis; Neurofibromatosis type 1; Deformity correction