PDF(Pubmed)
Abstract：
OBJECTIVE: Currently, anterior-only (AO), posterior-only, and combined anterior-posterior spinal fusions are common strategies for treating cervical kyphosis in patients with neurofibromatosis-1 NF-1. Nevertheless, the choice of surgical strategy remains a topic of controversy. The aim of our study is to evaluate the safety and effectiveness of anterior decompression and spinal reconstruction for the treatment of cervical kyphosis in patients with NF-1.
METHODS: Twelve patients with NF-1-associated cervical kyphotic deformity were reviewed retrospectively between January 2010 and April 2020. All patients underwent AO correction and reconstruction. The X-ray was followed up in all these patients to assess the preoperative and postoperative local kyphosis angle (LKA), the global kyphosis angle (GKA), the sagittal vertical axis, and the T1 slope. The visual analog scale score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI) score were used to evaluate the improvement inclinical symptoms. The results of the difference in improvement from preoperatively to the final follow-up assessment were assessed using a paired t-test or Mann-Whitney U-test.
RESULTS: The LKA and GKA decreased from the preoperative average of 64.42 (range, 38-86) and 35.50 (range, 10-81) to an average of 16.83 (range, -2 to 46) and 4.25 (range, -22 to 39) postoperatively, respectively. The average correction rates of the LKA and GKA were 76.11% and 111.97%, respectively. All patients had achieved satisfactory relief of neurological symptoms (p < 0.01). JOA scores were improved from 10.42 (range, 8-16) preoperatively to 15.25 (range, 11-18) at final follow-up (p < 0.01). NDI scores were decreased from an average of 23.25 (range, 16-34) preoperatively to an average of 7.08 (range, 3-15) at the final follow-up (p < 0.01).
CONCLUSIONS: Anterior-only correction and reconstruction is a safe and effective method for correcting cervical kyphosis in NF-1 patients. In fixed cervical kyphosis cases, preoperative skull traction should also be considered.
METHODS: Twelve patients with NF-1-associated cervical kyphotic deformity were reviewed retrospectively between January 2010 and April 2020. All patients underwent AO correction and reconstruction. The X-ray was followed up in all these patients to assess the preoperative and postoperative local kyphosis angle (LKA), the global kyphosis angle (GKA), the sagittal vertical axis, and the T1 slope. The visual analog scale score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI) score were used to evaluate the improvement inclinical symptoms. The results of the difference in improvement from preoperatively to the final follow-up assessment were assessed using a paired t-test or Mann-Whitney U-test.
RESULTS: The LKA and GKA decreased from the preoperative average of 64.42 (range, 38-86) and 35.50 (range, 10-81) to an average of 16.83 (range, -2 to 46) and 4.25 (range, -22 to 39) postoperatively, respectively. The average correction rates of the LKA and GKA were 76.11% and 111.97%, respectively. All patients had achieved satisfactory relief of neurological symptoms (p < 0.01). JOA scores were improved from 10.42 (range, 8-16) preoperatively to 15.25 (range, 11-18) at final follow-up (p < 0.01). NDI scores were decreased from an average of 23.25 (range, 16-34) preoperatively to an average of 7.08 (range, 3-15) at the final follow-up (p < 0.01).
CONCLUSIONS: Anterior-only correction and reconstruction is a safe and effective method for correcting cervical kyphosis in NF-1 patients. In fixed cervical kyphosis cases, preoperative skull traction should also be considered.
摘要：
目标：目前，仅前(AO)，仅后部，和联合前后脊柱融合是治疗神经纤维瘤病-1NF-1患者颈椎后凸畸形的常用策略。然而，手术策略的选择仍然是一个有争议的话题.我们研究的目的是评估前路减压和脊柱重建治疗NF-1患者颈椎后凸畸形的安全性和有效性。
方法：回顾性分析了2010年1月至2020年4月期间12例NF-1相关宫颈后凸畸形患者的临床资料。所有患者均行AO矫正和重建。对所有患者进行X线随访,评估术前及术后局部后凸角度(LKA),整体后凸角度（GKA），矢状垂直轴，和T1斜率。视觉模拟量表评分，日本骨科协会（JOA）评分，颈部残疾指数（NDI）评分用于评估临床症状的改善情况。使用配对t检验或Mann-WhitneyU检验评估从术前到最终随访评估的改善差异的结果。
结果：LKA和GKA较术前平均值64.42（范围，38-86）和35.50（范围，10-81）的平均值为16.83（范围，-2到46）和4.25（范围，-22至39）术后，分别。LKA和GKA的平均矫正率分别为76.11%和111.97%,分别。所有患者神经症状均得到满意缓解(p<0.01)。JOA评分从10.42分提高(范围，8-16）术前为15.25（范围，11-18）在最终随访时（p<0.01）。NDI分数从平均23.25下降(范围，16-34）术前平均为7.08（范围，3-15）在最终随访时（p<0.01）。
结论：仅前路矫正和重建是矫正NF-1患者颈椎后凸的一种安全有效的方法。在固定的颈椎后凸畸形病例中，术前颅骨牵引也应考虑。
方法：回顾性分析了2010年1月至2020年4月期间12例NF-1相关宫颈后凸畸形患者的临床资料。所有患者均行AO矫正和重建。对所有患者进行X线随访,评估术前及术后局部后凸角度(LKA),整体后凸角度（GKA），矢状垂直轴，和T1斜率。视觉模拟量表评分，日本骨科协会（JOA）评分，颈部残疾指数（NDI）评分用于评估临床症状的改善情况。使用配对t检验或Mann-WhitneyU检验评估从术前到最终随访评估的改善差异的结果。
结果：LKA和GKA较术前平均值64.42（范围，38-86）和35.50（范围，10-81）的平均值为16.83（范围，-2到46）和4.25（范围，-22至39）术后，分别。LKA和GKA的平均矫正率分别为76.11%和111.97%,分别。所有患者神经症状均得到满意缓解(p<0.01)。JOA评分从10.42分提高(范围，8-16）术前为15.25（范围，11-18）在最终随访时（p<0.01）。NDI分数从平均23.25下降(范围，16-34）术前平均为7.08（范围，3-15）在最终随访时（p<0.01）。
结论：仅前路矫正和重建是矫正NF-1患者颈椎后凸的一种安全有效的方法。在固定的颈椎后凸畸形病例中，术前颅骨牵引也应考虑。
