Abstract
Introduction
Patients with nondystrophic scoliosis caused by NF-1 mostly require surgery. Although the radiographic findings in patients with nondystrophic scoliosis secondary to NF-1 are similar to those in patients with idiopathic scoliosis, evidence-based surgical guidelines, and long-term results are not as established as those for patients with AIS. The objective of this study is to compare the surgical outcomes of nondystrophic scoliosis secondary to neurofibromatosis type I (NF-1) and curve-matched adolescent idiopathic scoliosis (AIS) to identify the feasibility of treating nondystrophic NF-1 using the same principals as AIS and seek for potential surgical improvement.
Patients and Methods
A total of 19 adolescent patients with nondystrophic scoliosis secondary to NF-1 and 19 curve-matched patients with AIS were recruited into the study. Preoperative immediately and 6-month postoperative, and follow-up radiological data were reviewed and analyzed. The mean age of patients with NF-1 was 14.4 ± 1.3 years compared with 15.7 ± 3.1 years of patients with AIS. The main curves were 70.1 ± 14.4 and 75.9 ± 11.3 degrees for the patients with NF-1 and AIS, respectively. The minor curves were 37.4 ± 14.2 and 39.5 ± 13.4 degrees for the patients with NF-1 and AIS, respectively. The mean follow-up durations were 33.8 months (range, 24–60 months) and 31.6 months (range, 24–41 months) for the NF-1 and AIS groups, respectively.
Results
After surgery, the nondystrophic NF-1 group had less main curve correction (62.3 ± 15.5 vs. 68.9 ± 13.2%, p < 0.001), less apical vertebral translation (AVT) correction (−20.3 vs. −22.9 mm, p = 0.019), and less trunk shift (TS) correction (−7.8 vs. −16.0 mm, p < 0.001). On the sagittal plane, significantly more correction of sagittal vertical axis (SVA) (−19.3 vs. −10.0 mm, p = 0.041) was noted in the nondystrophic NF-1 group. A significant trend to worse was observed in NF-1 group during the follow-up period. At the final follow-up, significantly more loss of correction (5.4 vs. −0.8 degrees, p = 0.013) of the main curve was observed in the nondystrophic NF-1 group.
Conclusion
Current results suggest that satisfactory short-term surgical outcomes can be achieved in both NF-1 patients with non-dystrophic scoliosis and patients with AIS while sharing the same management strategy. However, the long-term result of nondystrophic scoliosis in patients with NF-1 is not identical to that of patients with AIS. Despite all this, it is fair to suggest that applying the surgical strategy of AIS in treating nondystrophic scoliosis secondary to NF-1 should be acknowledged.