Surgical correction of dystrophic spinal curves in neurofibromatosis - A review of 56 patients

Study Design. A presentation of the results from 56 patients with dystrophic spinal deformities caused by neurofibromatosis surgically managed from 1971 to 1992. Objectives. To focus on the need for combined anterior and posterior fusion in the presence of severe spinal dystrophic changes. Summary of Background Data. It has been stated that the most effective management for dystrophic curves is early and aggressive surgery. Methods. The patients were divided into two groups: Type I scoliosis (kyphosis <50 degrees) and Type II kyphoscoliosis (kyphosis >50 degrees). Results were evaluated in relation to the type of surgery performed: single posterior instrumented fusion or preplanned combined anterior and posterior fusion. Results. At a mean follow-up period of 15 years (range, 5-22 years), all patients appeared to be stabilized, after a total of 120 surgical interventions. In Group I, the posterior instrumented fusion failed in nine patients (47%), and in Group II it failed in seven patients (63%). The preplanned combined anterior and posterior fusion failed in two patients (33%) in Group I and in four patients (20%) in Group II. The failure incidence of the posterior instrumented fusion alone and of the planned anterior and posterior fusion was 53% (16 patients) and 23% (6 patients), respectively. Conclusions. The severe dystrophic curve with anterior vertebral scalloping always requires combined anterior and posterior stabilization, particularly in younger patients, even if the sagittal curves have not become pathologic by the time of presentation.