Halo-pelvic traction for thoracic spine dislocation in neurofibromatosis type 1: a case series

Purpose To present a case series of 6 patients with Neurofibromatosis type 1 (NF-1) who had severe kyphoscoliosis with vertebral dislocation, and were treated with halo-pelvic traction (HPT) and posterior fusion. To discuss the pathological characteristics of this rare entity, and report our experience using HPT to manage the condition. Methods From March, 2016 to September, 2017, 6 patients with severe kyphoscoliosis with vertebral dislocation were admitted for HPT and posterior surgery, and were followed for 2 years. Results The 6 patients received HPT for an average of 42 days. The average scoliosis Cobb angle was 131.2° before HPT, 69.9° after HPT, 52.7° after posterior surgery, and 51.7° at the 2-year follow-up. The average 2-year correction rate was 61.7%. The average kyphosis Cobb angle was 125.2° before HPT, 62.9° after HPT, 62.2° after posterior surgery, and 64.9° at the 2-year follow-up. The average 2-year correction rate was 46.5%. Proximal screw pull-out was found in one patient at the 3-month follow-up visit, but revision surgery was not needed. No patients experienced permanent neurological deficits or death. No screw malposition occurred in any patient. Conclusion HPT is a viable treatment option for vertebral dislocation in NF-1. After 6 weeks of traction, the vertebral dislocation, scoliosis, and kyphosis can be dramatically reduced, and thus the conditions for corrective surgery can be improved.