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All Pedicle Screw Instrumentation for Scoliosis Correction in Neurofibromatosis. Is it Worth It?: PAPER #55

Koptan, Wael MD; ElMiligui, Yasser MD, FRCS; El‐Sharkawi, Mohammad M. MD; Shafik, Fady S.; Arafa, AbdElMohsen

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Spine Journal Meeting Abstracts: 2011 - Volume - Issue - p 83
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Summary: A prospective study of 15 patients with Neurofibromatosis whose non dystrophic spinal deformities were corrected with a single stage all pedicle screws technique and compared to an earlier series of 13 patients who had a two staged procedure with hybrid posterior instrumentation. Patients were followed up for a minimum of 2 years. A better correction was achieved by all pedicle screws constructs; with significantly less blood loss, operative time, hospital stay and complications without the need for anterior surgery.

Introduction: Spinal deformities are considered the most common skeletal manifestation in Neurofibromatosis (NF) and have long been corrected by anterior fusion and posterior hybrid constructs. All pedicle screw constructs are currently widely used in the treatment of spinal deformities and accurate evaluation of this recent application in Neurofibromatosis patients is necessary. The aim of this work is to compare the results of segmental all pedicle screw constructs versus hybrid instrumentation analyzing the amount of correction achieved, clinical outcome and the incidence of complications.

Methods: The study included 28 patients with non dystrophic NF spinal deformities surgically treated between 1997 and 2008 and followed‐up for an average of 6y (range 2 ‐ 9y). It included 15 consecutive patients corrected by a single stage segmental all pedicle screw constructs (Group 1) compared to an earlier series of 13 patients who had an anterior release followed by posterior hybrid instrumentation (Group 2). The average age was 13y+8m and 14y+lm respectively. The average preoperative scoliosis was 63.6 degrees (Group 1) and 61.2 degrees (Group 2).

Results: A significantly better correction was achieved in Group 1 with an average of 81.2% postoperatively and 1.2% correction loss at final follow‐up compared to Group 2 where correction was 73.8% postoperatively and 2.5% correction loss at final follow‐up. The average operative time and blood loss were considerably less in Group 1 with an average of 4.5 h and 740 cc than Group 2 with an average of 6.45 h and 1050 cc respectively. Group 2 patients had a longer hospital stay and had 4 complications in 4/13 patients.

Conclusion: A better correction of non dystrophic spinal deformities was achieved in NF patients by multiple levels all pedicle screws technique; with significantly less operative time, blood loss, hospital stay and complications.

© 2011 Lippincott Williams & Wilkins, Inc.