Травматология и ортопедия России. 2017; 23: 125-133
ПЕНЕТРАЦИЯ РЕБРОМ ПОЗВОНОЧНОГО КАНАЛА ПРИ СКОЛИОЗЕ НА ПОЧВЕ НЕЙРОФИБРОМАТОЗА I ТИПА (клинический случай и обзор литературы)
https://doi.org/10.21823/2311-2905-2017-23-3-125-133Аннотация
Введение. Случаи пенетрации ребром позвоночного канала у больных сколиозом на фоне нейрофиброматоза I типа (НФ-I) представлены в литературе весьма скромно, хотя на практике подобная патология встречается довольно часто и не всегда диагностируется.
Материал. Мы представляем наблюдение подростка с левосторонним грудным кифосколиозом на почве НФ-1 и пенетрацией позвоночного канала головкой ребра с развитием легкого неврологического дефицита.
Результаты. В нашей клинике проходил лечение 14-летний подросток с левосторонним грудным кифосколиозом на почве НФ-I (сколиоз 68°, кифоз 65°). Предоперационное КТ-исследование позволило диагностировать протрузию головки XI ребра слева в просвет позвоночного канала без сдавления дурального мешка. Проведено корригирующее вмешательство, включавшее резекцию головки XI ребра. Достигнуты хорошая коррекция обоих компонентов деформации позвоночника и уменьшение нарушений чувствительности.
Заключение. Проникновение головки ребра в позвоночный канал встречается при сколиозах на фоне НФ-I. Необходимо тщательно изучать данные лучевых методов исследования, поскольку характер деформации (диспластический) может затруднять выявление этого редкого состояния.
Список литературы
1. Crawford A.H., Parikh S., Schorry E., Von Stein D. The immature spine in type-I neurofibromatosis. J Bone Joint Surg. 2007;89-A(Suppl. 1):123-142. DOI: 10.2106/JBJS.F.00836.
2. Kim H.W., Weinstein S. Spine update. The management of scoliosis in neurofibromatosis. Spine. 1997;22( 23):27702776.
3. Cappella M., Bettini N., Dema E., Girardo M., Cervellati S. Late post-operative paraparesis after rib penetration of the spinal canal in a patient with neurofibromatous scoliosis. J Orthopaed Traumatol. 2008;9(3):163-166. DOI: 10.1007/s10195-008-0010-x.
4. Abdulian M., Liu R., Son-Hing J., Thompson G., Armstrong D. Double rib penetration of the spinal canal in a patient with neurofibromatosis. J Pediatr Ortop. 2011;31(1):6-10. DOI: 10.1097/BPO.0b013e3182032029.
5. Dacher J.N., Zakine S., Monroc M., Eurin D., Lecheval-lier J., Le Dosseur P. Rib displacement threatening the spinal cord in a scoliotic child with neurofibromatosis. Pediatric Radiology. 1995;25:58-59. DOI: 10.1007/BF02020851.
6. Deguchi M., Kawakami N., Saito H., Arao K., Mimatsu K., Iwata H. Paraparesis after rib penetration of the spinal canal in neurofibromatous scoliosis. J Spinal Disord. 1995;8(5):363-367.
7. Flood B.M., Butt W.P., Dickson R.A. Rib penetration of the intervertebral foraminae in neurofibromatosis. Spine (Phila Pa 1976). 1986;11(2):172-174.
8. G kiokas A., Hadzimichalis S., Vasiliadis E., Katsalouli M., Kannas G. Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis. Scoliosis. 2006;1:10.
9. Kamath S.V., Kleinman P.K., Ragland R.L., TenreiroPicon O.R., Knorr J.R., Davidson R.I., Shelton Y.A. Intraspinal dislocation of the rib in neurofibromatosis: a case report. Pediatr Radiol. 1995;25(7):538-539.
10. Khoshhal K.I., Ellis R.D. Paraparesis after posterior spinal fusion in neurofibromatosis secondary to rib displacement: case report and literature review. J Pediatr Orthop. 2000;20(6):799-801.
11. Major M.R., Huizenga B.A. Spinal cord compression by displaced ribs in neurofibromatosis. A report of three cases. J Bone Joint Surgery. 1988;70-A(7):1100-1102.
12. Mao S., Shi B., Wang S., Zhu C., Zhu Z., Qian B., Zhu F., Sun X., Liu Z., Qiu Y. Migration of the penetrated rib head following deformity correction surgery without rib head excision in dystrophic scoliosis secondary to type 1 Neurofibromatosis. Eur Spine J. 2015;24(7):1502-1509. DOI: 10.1007/s00586-014-3741-9.
13. Mukhtar I.A., Letts M., Kontio K. Spinal cord impingement by a displaced rib in scoliosis due to neurofibromatosis. J Can Chir. 2005;48(5):414-415.
14. Sun D., Dai F., Liu Y., Xu J.-Zh. Posterior-only spinal fusion without rib head resection for treating type 1 neurofibromatosis with intracanal rib head dislocation. Clinics (Sao Paulo). 2013;68(12):1521-1527. DOI: 10.6061/clinics/2013(12)08.
15. Ton J., Stein-Wexler R., Yen P., Gupta M. Rib head protrusion into the central canal in type 1 neurofibromatosis. Pediatr Radiol. 2010;40(12):1902-1909. DOI: 10.1007/s00247-010-1789-1.
16. Y alcin N., Bar-on E., Yazici M. Impingement of spinal cord by dislocated rib in dystrophic scoliosis secondary to neurofibromatosis Type 1. Radiologic signs and management strategies. Spine (Phila Pa 1976). 2008;33(23):E881-E886. DOI: 10.1097/BRS.0b013e318184efad.
Traumatology and Orthopedics of Russia. 2017; 23: 125-133
RIB PENETRATION INTO THE SPINAL CANAL IN CASES OF SCOLIOSIS IN PATIENTS WITH NEUROFIBROMATOSIS TYPE-1 (case report and literature review)
https://doi.org/10.21823/2311-2905-2017-23-3-125-133Abstract
Background. Rib penetration into the spinal canal in patients with scoliosis secondary to neurofibromatosis type-1 (NF-1) was described in a relatively small number of publications, though it’s common in clinical practice and not always diagnosed.
Materials. The authors report on an adolescent male with NF-1 left thoracic kyphoscoliosis and rib head protrusion into spinal canal with mild initial neurological deficit.
Results. A 14-year-old male patient with NF-1 and 68 degrees left thoracic scoliosis and 65 degrees kyphosis was undergoing treatment at the authors’ institution.Preoperative CT scans demonstrated protrusion of the left T11 rib head into the spinal canal on the convexity of the curve, without spinal cord compression. Surgical procedure for resection of the rib head and correction of the spinal deformity was performed which allowed to achieve good deformity correction. The authors also observed almost complete restoration of sensitive functions.
Conclusion. Rib head protrusion into the spinal canal can occur in cases of spine deformities with NF-1. If present, the imaging findings should be carefully reviewed for appearance of such lesion that may be obscured by the limitations of CT in the context of a dysplastic spinal deformity.
References
1. Crawford A.H., Parikh S., Schorry E., Von Stein D. The immature spine in type-I neurofibromatosis. J Bone Joint Surg. 2007;89-A(Suppl. 1):123-142. DOI: 10.2106/JBJS.F.00836.
2. Kim H.W., Weinstein S. Spine update. The management of scoliosis in neurofibromatosis. Spine. 1997;22( 23):27702776.
3. Cappella M., Bettini N., Dema E., Girardo M., Cervellati S. Late post-operative paraparesis after rib penetration of the spinal canal in a patient with neurofibromatous scoliosis. J Orthopaed Traumatol. 2008;9(3):163-166. DOI: 10.1007/s10195-008-0010-x.
4. Abdulian M., Liu R., Son-Hing J., Thompson G., Armstrong D. Double rib penetration of the spinal canal in a patient with neurofibromatosis. J Pediatr Ortop. 2011;31(1):6-10. DOI: 10.1097/BPO.0b013e3182032029.
5. Dacher J.N., Zakine S., Monroc M., Eurin D., Lecheval-lier J., Le Dosseur P. Rib displacement threatening the spinal cord in a scoliotic child with neurofibromatosis. Pediatric Radiology. 1995;25:58-59. DOI: 10.1007/BF02020851.
6. Deguchi M., Kawakami N., Saito H., Arao K., Mimatsu K., Iwata H. Paraparesis after rib penetration of the spinal canal in neurofibromatous scoliosis. J Spinal Disord. 1995;8(5):363-367.
7. Flood B.M., Butt W.P., Dickson R.A. Rib penetration of the intervertebral foraminae in neurofibromatosis. Spine (Phila Pa 1976). 1986;11(2):172-174.
8. G kiokas A., Hadzimichalis S., Vasiliadis E., Katsalouli M., Kannas G. Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis. Scoliosis. 2006;1:10.
9. Kamath S.V., Kleinman P.K., Ragland R.L., TenreiroPicon O.R., Knorr J.R., Davidson R.I., Shelton Y.A. Intraspinal dislocation of the rib in neurofibromatosis: a case report. Pediatr Radiol. 1995;25(7):538-539.
10. Khoshhal K.I., Ellis R.D. Paraparesis after posterior spinal fusion in neurofibromatosis secondary to rib displacement: case report and literature review. J Pediatr Orthop. 2000;20(6):799-801.
11. Major M.R., Huizenga B.A. Spinal cord compression by displaced ribs in neurofibromatosis. A report of three cases. J Bone Joint Surgery. 1988;70-A(7):1100-1102.
12. Mao S., Shi B., Wang S., Zhu C., Zhu Z., Qian B., Zhu F., Sun X., Liu Z., Qiu Y. Migration of the penetrated rib head following deformity correction surgery without rib head excision in dystrophic scoliosis secondary to type 1 Neurofibromatosis. Eur Spine J. 2015;24(7):1502-1509. DOI: 10.1007/s00586-014-3741-9.
13. Mukhtar I.A., Letts M., Kontio K. Spinal cord impingement by a displaced rib in scoliosis due to neurofibromatosis. J Can Chir. 2005;48(5):414-415.
14. Sun D., Dai F., Liu Y., Xu J.-Zh. Posterior-only spinal fusion without rib head resection for treating type 1 neurofibromatosis with intracanal rib head dislocation. Clinics (Sao Paulo). 2013;68(12):1521-1527. DOI: 10.6061/clinics/2013(12)08.
15. Ton J., Stein-Wexler R., Yen P., Gupta M. Rib head protrusion into the central canal in type 1 neurofibromatosis. Pediatr Radiol. 2010;40(12):1902-1909. DOI: 10.1007/s00247-010-1789-1.
16. Y alcin N., Bar-on E., Yazici M. Impingement of spinal cord by dislocated rib in dystrophic scoliosis secondary to neurofibromatosis Type 1. Radiologic signs and management strategies. Spine (Phila Pa 1976). 2008;33(23):E881-E886. DOI: 10.1097/BRS.0b013e318184efad.
