Halo-pelvic traction for thoracic spine dislocation in neurofibromatosis type 1: a case series.

Journal: Archives Of Orthopaedic And Trauma Surgery
Published:
Abstract

Objective: To present a case series of 6 patients with Neurofibromatosis type 1 (NF-1) who had severe kyphoscoliosis with vertebral dislocation, and were treated with halo-pelvic traction (HPT) and posterior fusion. To discuss the pathological characteristics of this rare entity, and report our experience using HPT to manage the condition.

Methods: From March, 2016 to September, 2017, 6 patients with severe kyphoscoliosis with vertebral dislocation were admitted for HPT and posterior surgery, and were followed for 2 years.

Results: The 6 patients received HPT for an average of 42 days. The average scoliosis Cobb angle was 131.2° before HPT, 69.9° after HPT, 52.7° after posterior surgery, and 51.7° at the 2-year follow-up. The average 2-year correction rate was 61.7%. The average kyphosis Cobb angle was 125.2° before HPT, 62.9° after HPT, 62.2° after posterior surgery, and 64.9° at the 2-year follow-up. The average 2-year correction rate was 46.5%. Proximal screw pull-out was found in one patient at the 3-month follow-up visit, but revision surgery was not needed. No patients experienced permanent neurological deficits or death. No screw malposition occurred in any patient.

Conclusions: HPT is a viable treatment option for vertebral dislocation in NF-1. After 6 weeks of traction, the vertebral dislocation, scoliosis, and kyphosis can be dramatically reduced, and thus the conditions for corrective surgery can be improved.

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