Comparison of Outcomes in Three Surgical Approaches for Dystrophic Cervical Kyphosis in Patients with Neurofibromatosis Type Ⅰ.

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Comparison of Outcomes in Three Surgical Approaches for Dystrophic Cervical Kyphosis in Patients with Neurofibromatosis Type Ⅰ.

World Neurosurg. 2017 Dec 08;:

Authors: Lin T, Shao W, Zhang K, Gao R, Zhou X

Abstract
OBJECTIVE: This study compares the outcomes of anterior-only (AO), posterior-only (PO), and anteroposterior (AP) surgical approaches for the treatment of dystrophic cervical kyphosis in patients with neurofibromatosis type I (NF1).
METHODS: A total of 81 patients with dystrophic cervical kyphosis due to NF1 were included in our retrospective observational study. Length of kyphosis, duration of halo-traction, cobb angle, C2-7-SVA, T1 slope, NDI (Neck Disability Index), and complications after surgery were evaluated before and, if possible, after each surgical approach.
RESULTS: The AP approach provided the best outcomes (average spinal Cobb angle was corrected from 61.2 ± 9.1° to 5.7 ± 3.2°, p<0.05), while there was no significant difference between the AO and PO approaches (p>0.05). With regard to cervical sagittal balance, the AP approach had the most improvements of C2-7-SVA (mean C2-7-SVA was corrected from 3.2±9.2mm to 12.8±2.6mm, p<0.05), meanwhile the difference between the AO and PO approach had no statistical difference (p>0.05); the T1 slopes results were similar to those of C2-7-SVA. NDI score of all patients improved significantly after surgery (p<0.05); specifically patients who had an AP approach made up the largest portion of the satisfied patient group. Post-operative junctional kyphosis occurred in 11 patients total, 1 undergoing an AP approach, 6 undergoing an AO approach, and 4 undergoing a PO approach; these findings correlated with those patients with ≤ 5 fused segments.
CONCLUSIONS: AP approach surgery provided the best correction of dystrophic cervical kyphosis and sagittal balance for patients with neurofibromatosis type I. Patients undergoing an AP approach were more satisfied with their outcomes. Junctional kyphosis could be prevented effectively using an AP approach in patients with >5 fused segments.

PMID: 29229345 [PubMed - as supplied by publisher]

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