Video-Assisted Thoracoscopic Lateral Interbody Fusion for Symptomatic Pseudarthrosis in Neurofibromatosis 1-Associated Spinal Deformity

• Published in: World neurosurgery 2024-05, Vol.185, p.95-102
• Main Authors: Nemani, Venu M., Eley, Nicholas, Hubka, Michal, Sethi, Rajiv K.
• Format: Article
• Language: English
• Subjects: Humans; Male; Neurofibromatosis 1 - complications; Neurofibromatosis 1 - surgery; NF1; Pseudarthrosis; Pseudarthrosis - etiology; Pseudarthrosis - surgery; Scoliosis; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spinal deformity; Spinal Fusion - methods; Thoracic Surgery, Video-Assisted - methods; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; VATS; Video-assisted thoracoscopic surgery
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.01.151

The treatment of symptomatic pseudarthrosis via posterior-only approaches in the setting of neurofibromatosis 1 (NF1) is challenging due to dural ectasias, resulting in erosion of the posterior elements. The purpose of this report is to illustrate a minimally invasive method for performing anterior thoracic fusion for pseudarthrosis in a patient with NF1-associated scoliosis and dysplastic posterior elements. To the best of our knowledge, this is the first documented case of using video-assisted thoracoscopic lateral interbody fusion to treat pseudarthrosis for NF1-associated spinal deformity. The patient underwent video-assisted thoracoscopic anterior spinal fusion via a direct lateral interbody approach with interbody cage placement at T10-T11 and T11-T12, followed by revision of his posterior spinal fusion and instrumentation. The patient had an uneventful postoperative course. At 6 months of follow-up, the patient had complete resolution of his preoperative symptoms and had returned to full-time work with no complaints. At 3 years postoperatively, the patient reported being satisfied with the operation and had continued to work full-time without restrictions. To the best of our knowledge, this is the first report of pseudarthrosis in the setting of NF1-associated scoliosis treated via minimally invasive anterior thoracic fusion facilitated by video-assisted thoracoscopic surgery. This is a powerful technique that allows for safe access for anterior thoracic fusion in the setting of dysplastic posterior anatomy and poor posterior bone stock.