ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Distal fusion vertebra selection in neurofibromatosis type 1 scoliosis: integrating CT/MRI-detected atrophic changes reduces long-term mechanical complications.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDistal fusion vertebra (DFV) selection in neurofibromatosis type 1 (NF1) scoliosis is traditionally guided by adolescent idiopathic scoliosis (AIS) criteria, which do not account for NF1-specific atrophic changes. We evaluated whether integrating preoperative CT/MRI-detected atrophic changes into DFV selection reduces long-term mechanical complications.
methodsThis retrospective cohort study included 156 NF1 scoliosis patients (Lenke 1-3, Cobb ≥ 45°) undergoing posterior spinal fusion (2010-2018) with a minimum 5-year follow-up. Patients were stratified into an optimized group (AIS criteria plus CT/MRI atrophic assessment) and a traditional group (AIS criteria alone). Propensity score matching (1:1) yielded 65 matched pairs. Primary outcomes were internal fixation failure (IFF) and distal adding-on. Multivariate logistic regression and ROC analysis were performed.
resultsThe optimized group demonstrated lower IFF (12.3% vs. 32.3%; OR 0.29, 95% CI 0.12-0.68; p = 0.002) and distal adding-on (15.4% vs. 40.0%; OR 0.27, 95% CI 0.12-0.60; p < 0.001). Absolute risk reductions were 20.0% (IFF) and 24.6% (adding-on), corresponding to numbers needed to treat of 5 and 4, respectively. Correction magnitude and fusion length were comparable between groups. DFV adjacency to vertebral (OR 6.12), disc (OR 5.37), and paraspinal soft-tissue atrophy (OR 4.89) independently predicted complications. Combined CT/MRI assessment demonstrated good discrimination (AUC = 0.87; sensitivity 82.6%, specificity 80.3%).
conclusionIntegration of CT/MRI-detected atrophic changes into DFV selection was associated with significantly reduced long-term mechanical complications without compromising deformity correction in NF1 scoliosis.
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