High-grade spondyloretrolisthesis in a 12-year-old girl with neurofibromatosis type 1: a case report and literature review
| Autor: | Ana María Martín-Fuentes, Rafael Viña-Fernández, Angel Curto de la Mano, Juan Pretell-Mazzini |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Neurofibromatosis 1 Time Factors Arthrodesis medicine.medical_treatment Kyphosis Risk Assessment Severity of Illness Index Boston brace Lumbar Postoperative Complications medicine Back pain Humans Orthopedics and Sports Medicine Neurofibromatosis Child Gait Pain Measurement Lumbar Vertebrae business.industry Dural ectasia Laminectomy medicine.disease Magnetic Resonance Imaging Spondylolisthesis Surgery Radiography Spinal Fusion Treatment Outcome Scoliosis Pediatrics Perinatology and Child Health Female medicine.symptom business Follow-Up Studies |
| Zdroj: | Journal of pediatric orthopedics. Part B. 22(2) |
| ISSN: | 1473-5865 |
| Popis: | Neurofibromatosis (NF) type 1 is characterized by several skin, endocrine, central nervous system and musculoskeletal manifestations, spine deformities being the most common, affecting up to 64% of patients. Thoracic kyphoscoliosis is the most common deformity observed; however, high-grade spondylolisthesis and dural defects such as dural ectasia can also be found. The aim of this study is to describe a case of high-grade spondyloretrolisthesis in an NF-1 patient, associated with dural ectasia and extensive lumbar laminectomies, and to discuss our management and review the current literature on this controversial topic. A 12-year-old girl with NF-1 who had undergone extensive lumbar laminectomies in an outside facility presented to our emergency department complaining of back pain and lower limbs upper motor neuron symptoms. Image studies showed a high-grade lumbar spondyloretrolisthesis associated with dural ectasia. The first step of treatment was spine immobilization using a Boston brace. An anterior approach was used, and an L2 corporectomy was performed, using a Moss type cage between L1 and L3 with an instrumented arthrodesis and autologous bone graft for stabilization purposes. The second step planned was a posterior approach for arthrodesis and instrumentation, but after an extensive discussion with the parents and the patient, the parents did not agree to the procedure planned for the patient. A brace was used for 1 year while rehabilitation was performed. At the 1-year follow-up, there was a 70° kyphosis at the thoracolumbar junction but it was clinically stable, with an acceptable sagittal balance. Dural ectasia is not a common finding in children with NF-1; however, it should be identified as its presence may predispose to spine instability and as a consequence the development of a high-grade spondyloretrolisthesis. Even though a few cases have been reported, we believe that it is important to consider the option of a double approach to achieve a better correction in both planes and a good outcome. If an extensive laminectomy is involved, it is mandatory to perform a posterior fusion and instrumentation. |
| Databáze: | OpenAIRE |
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