[Analysis of the efficacy of halo-pelvic traction combined with posterior osteotomy in the treatment of severe rigid neurofibromatosis type 1 kyphoscoliosis].

Objective: To explore the clinical efficacy of halo-pelvic traction combined with posterior osteotomy in the treatment of severe rigid type I neurofibromatosis (NF-1) scoliosis. Methods: This is a retrospective case series study. The clinical data of 13 patients with severe rigid NF-1 scoliosis admitted to the Department of Pediatric Orthopedics (Scoliosis Specialty) of Zhengzhou Orthopedic Hospital from March 2017 to June 2024 were retrospectively analyzed. There were 6 males and 7 females, with an age of (17.5 7.2) years (range: 11 to 39 years). After 6 to 9 weeks of halo-pelvic traction, all patients underwent posterior spinal corrective surgery. The traction time, height, coronal Cobb angle of the main curve, sagittal Cobb angle, trunk balance indicators, and pulmonary function before and after traction and after corrective surgery were collected. The comparison of repeated measurement data was conducted using repeated measures analysis of variance, and pairwise comparisons were performed using the LSD-t test. Results: The traction time of the 13 patients was (55.5 5.8) d(range: 47 to 65 d). All 13 patients underwent posterior osteotomy in the apical vertebra area with Ponte osteotomy and non-apical vertebra area with facet osteotomy for correction. The height increased from (149.1 3.1) cm (range: 132 to 153 cm) before traction to (158.8 2.9) cm (range: 139 to 162 cm) after traction and (157.0 3.1) cm (range: 149 to 160 cm) after corrective surgery (F=-37.641, P<0.01). The coronal Cobb angle of the main curve decreased from (111.4 15.6) (range: 96 to 150 ) before traction to (77.3 4.6) (range: 68 to 83 ) after traction and (58.2 4.1) (range: 52 to 64 ) after corrective surgery (F=100.637, P<0.01); the sagittal Cobb angle decreased from (97.8 11.2) (range: 90 to 135 ) before traction to (69.6 4.8) (range: 63 to 77 ) after traction and (54.5 2.6) (range: 50 to 58 ) after corrective surgery (F=119.930, P<0.01). All patients showed varying degrees of improvement in pulmonary function. The vital capacity increased from (1.1 0.1) L before traction to (1.2 0.1) L after traction,and (1.4 0.1)L after corrective surgery (F=75.004,P<0.01); the forced expiratory volume in one second increased from (0.9 0.1) L before traction to (1.1 0.1) L after traction,and (1.3 0.1)L after corrective surgery (F=92.937,P<0.01). No complications such as pin tract loosening or infection occurred during traction. Two patients developed brachial plexus nerve injury symptoms in the later stage of traction, which were relieved after symptomatic treatment. The postoperative follow-up period was (47.8 24.7) months (range: 12 to 87 months). The patient's bone graft has healed well, and there is no loosening, fracture or displacement of the spinal internal fixation. Conclusion: Halo-pelvic traction combined with posterior low-level osteotomy is effective in improving spinal deformity and trunk balance, enhancing pulmonary function, and achieving stable and satisfactory corrective results in the treatment of severe rigid NF-1 scoliosis. NF-1 2017 3 2024 6 13 NF-1 6 7 17.5 7.2 11~39 6~9 Cobb LSD-t 13 55.5 5.8 d 47~65 d Ponte 149.1 3.1 cm 132~153 cm 158.8 2.9 cm 139~162 cm 157.0 3.1 cm 149~160 cm F=37.641 P<0.01 Cobb 111.4 15.6 96 ~150 77.3 4.6 68 ~83 58.2 4.1 52 ~64 F=100.637 P<0.01 Cobb 97.8 11.2 90 ~135 69.6 4.8 63 ~77 54.5 2.6 50 ~58 F=119.930 P<0.01 1.1 0.1 L 1.2 0.1 L 1.4 0.1 L F=75.004 P<0.01 FEV1 0.9 0.1 L 1.1 0.1 L 1.3 0.1 L F=92.937 P<0.01 2 47.8 24.7 12~87 NF-1 .