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 neurofibroma was confirmed 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.

Figure 1

Preoperative anteroposterior (A) and lateral (B) X-rays, axial (C and D) and 3-dimensional (E and F) computed tomography of the rotational dislocation of the L2 to L3.

Figure 2

Preoperative magnetic resonance imaging (MRI) (A) and enhanced MRI (B) showing a large paravertebral mass and dural ectasia without intraspinal tumor.

Figure 3

Postoperative anteroposterior (A) and lateral (B) X-rays showing achievements of vertebral reduction and kyphosis correction.

Figure 4

Anteroposterior (A) X-ray and sagittal (B) computed tomography of 13-month follow-up showing good alignment and solid fusion.