Spontaneous rotational dislocation of the lumbar spine in type 1 neurofibromatosis : A case report and literature review

Abstract

Rationale: Scoliosis is the most common form of dystrophic spinal deformities in type 1 neurofibromatosis, whereas a spontaneous rotational dislocation of the lumbar spine is a rare entity. Former researchers had advocated the use of circumferential fusion performed through combined anterior-posterior approaches as the mode of treatment of this situation, but we managed to achieve a solid circumferential fusion equally using posterior approach alone. Patient concerns: A 51-year-old lady presented with severe back pain and no history of trauma, fever, or loss of weight. On examination, she showed several café-au-lait spots on her body and no neurologic deficit. Diagnoses: The imageology revealed a rotational dislocation of the L2 to L3. The diagnosis of neurofibromawasconfirmed by biopsy. Interventions: The patient underwent posterior reduction, combined intervertebral-posterolateral fusion, and internal fixation with screws and rods. Outcomes: The patient was satisfied with the back pain relief after surgery and able to live a normal life at follow-up. The imageology showed a good correction of the deformity with a solid bony fusion. Lessons: Special attention must be paid to patients who have neurofibromatosis and unexplained back pain for early diagnosis. Early circumferential fusion to reconstruct a stable spine is the key to treatment. Given the result of this case, the prognosis is promising following posterior surgery alone. Abbreviations: CT = computed tomography, L2 = the 2nd lumbar vertebrae (and so on), MRI = magnetic resonance imaging, NF = neurofibromatosis, NF-1 = type 1 neurofibromatosis, PCO = posterior column osteotomy, PEEK = polyetheretherketone, SEP = somatosensory evoked potential, VAS = visual analog scale.