Outcomes of Surgical Intervention of Dystrophic Cervical Kyphosis in Patients with Neurofibromatosis Type 1: A Systematic Review.

Background: Spinal deformities occur in 10 to 77% of neurofibromatosis type 1 (NF1) cases. The dystrophic type of NF1 progresses rapidly and can cause severe neurological complications if left untreated. Surgical intervention is necessary, as bracing is ineffective. Although the joint anterior-posterior (AP) approach provides better correction than single approaches, it carries higher surgical risks, leading to an ongoing debate about optimal treatment strategies. Methods: A systematic search was conducted across the Scopus, Embase, PubMed, and Google Scholar databases from inception to June 2024. Data on clinical characteristics, treatment approaches, radiological and functional outcomes, and complications were systematically collected and synthesized in a narrative format. Results: Six studies involving 124 patients were analyzed, comprising five case series and one retrospective observational study. The AP approach showed better correction outcomes than the anterior-only (AO) and posterior-only approaches. All surgical approaches resulted in significant functional improvements, as reflected by increased Japanese Orthopaedic Association/modified Japanese Orthopaedic Association scores, decreased Visual Analog Scale scores, and reduced Neck Disability Index scores. However, the AP approach was associated with a higher incidence of complications, while the AO approach had the lowest incidence. Conclusions: Existing evidence demonstrates that the AP approach leads to a better degree of correction than the AO or posterior-only approaches, despite higher complication rates. The dual mechanism of anterior reconstruction and posterior stabilization effectively addresses the challenges associated with dystrophic cervical kyphosis in patients with NF1.