• Zhenyu Wang, Changfeng Fu, Jiali Leng, Zhigang Qu, Feng Xu, and Yi Liu.
• Spine Department, First Hospital of Jilin University, No. 71, Xinmin St, Chaoyang District, ChangChun City, Jilin Province 130021, People's Republic of China.
• Spine J. 2015 Apr 1;15(4):587-95.

Background ContextCorrective surgery for dystrophic scoliosis in neurofibromatosis Type 1 (NF-1) is challenging. There are various surgical methods, all with unsatisfactory outcomes.PurposeThe purpose of the study was to evaluate the clinical outcomes of the treatment of dystrophic scoliosis in NF-1 with one-stage posterior pedicle screw approach.Study DesignThis is a retrospective clinical study.Patient SampleSixteen patients with dystrophic scoliosis in NF-1 underwent one-stage posterior surgery with pedicle screw system.Outcome MeasurementWe used preoperative and postoperative whole-spine radiographs to determine coronal and sagittal Cobb angles (curve correction); distance between apex vertebra and central sacral vertical line (DAC), pelvic obliquity, and shoulder tilt (coronal balance improvement); and sagittal vertical axis and pelvic tilt angle (sagittal balance improvement). We assessed the fusion rate using fusion segment computed tomography scan.MethodsPatients underwent surgery with or without osteotomy according to spinal flexibility. Fusion segment selection method of fusion segments selection which mean fusing from one or two levels proximal to upper end vertebra to one or two levels distal to the lower end vertebra (EV+1 or 2) or stable vertebrae fusion. There were no study-specific conflict of interest-associated biases.ResultsThe average follow-up time was 40.9 months. Mean scoliosis and kyphosis improved from 83.2° to 27.6° and 58.5° to 26.8°, respectively; at the last follow-up, it was 30.4° and 27.4°, respectively. Mean DAC, pelvic obliquity, and shoulder tilt improved from 53.0 to 23.9, 8.1 to 4.9, and 9.8 to 7.5 mm, respectively. Sagittal vertical axis and pelvic tilt angle improved from -5.8 to 1.6 mm and 17.9° to -5.8°, respectively. During follow-up, mean coronal and sagittal correction losses were 2.8° and 0.7°, respectively. Two EV+1 or 2 patients had decompensation. No pseudoarthrosis was identified.ConclusionsThe one-stage posterior pedicle screw approach is safe and effective in the treatment of dystrophic scoliosis in NF-1. Posterior vertebral column resection is recommended if flexibility is less than 35%. Stable vertebrae fusing is recommended.Copyright © 2015 Elsevier Inc. All rights reserved.

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