Spontaneous rotational dislocation of the lumbar spine in type 1 neurofibromatosis: A case report and literature review

Rationale: Scoliosis is the most common form of dystrophic spinal deformities in type 1 neurofibromatosis, whereas a spontaneous rotational dislocation of the lumbar spine is a rare entity. Former researchers had advocated the use of circumferential fusion performed through combined anterior-posterior approaches as the mode of treatment of this situation, but we managed to achieve a solid circumferential fusion equally using posterior approach alone. Patient concerns: A 51-year-old lady presented with severe back pain and no history of trauma, fever, or loss of weight. On examination, she showed several café-au-lait spots on her body and no neurologic deficit. Diagnoses: The imageology revealed a rotational dislocation of the L2 to L3. The diagnosis of neurofibroma was confirmed by biopsy. Interventions: The patient underwent posterior reduction, combined intervertebral-posterolateral fusion, and internal fixation with screws and rods. Outcomes: The patient was satisfied with the back pain relief after surgery and able to live a normal life at follow-up. The imageology showed a good correction of the deformity with a solid bony fusion. Lessons: Special attention must be paid to patients who have neurofibromatosis and unexplained back pain for early diagnosis. Early circumferential fusion to reconstruct a stable spine is the key to treatment. Given the result of this case, the prognosis is promising following posterior surgery alone.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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CONCLUSIONS: The clinical polymorphism effectiveness outlined therein will be assured by diagnostic improvements suitable for driving treatment decisions. In light of our experimental results and literature data, the analysis of the SLCO1B1 T521C variant will allow clinicians to take advantage from a better treatment planned for their patients in order to minimize neuromuscular pain and maximize benefits. PMID: 31957862 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Authors: Nakamura K, Sugai A, Saji E, Kasuga K, Onodera O Abstract Myositis generally affects the proximal muscles. However, we herein report a case of a 48-year-old woman with intractable myositis affecting the intrinsic muscles of the hands. Her myositis, which developed in childhood, was refractory to treatment with steroids and several immunosuppressants, causing walking disability. After experiencing pain and swelling in the hands for six months, she was diagnosed with myositis of the intrinsic muscles of the hands and tested positive for the anti-signal recognition particle antibody. Intravenous immunoglobuli...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
Publication date: 1 May 2020Source: Chemical Engineering Journal, Volume 387Author(s): Yuan Gao, Hong-Fei Xiang, Xiao-Xiong Wang, Kang Yan, Qi Liu, Xin Li, Rui-Qiang Liu, Miao Yu, Yun-Ze LongAbstractIn situ fiber deposition technology has shown great excellence in visceral hemostasis. In recent years, minimally invasive surgery has been widely welcomed by patients because of its small trauma, light pain and rapid recovery. In the treatment of minimally invasive surgical wounds, fiber deposition has the advantages of fast, convenient, disassemble free and low toxicity. However, due to the conductive nature of the human body...
Source: Chemical Engineering Journal - Category: Chemistry Source Type: research
A 72-year-old man was admitted to the hospital with diabetic ketoacidosis and acute kidney injury 3 months after receiving a deceased-donor kidney transplant. He had undergone induction immunosuppression with rabbit-antithymocyte globulin and took tacrolimus and mycophenolic acid for maintenance immunosuppression. Twelve days prior to admission to the hospital, right knee pain and swelling developed. Synovial fluid was aspirated and showed a white blood cell count of 1825, 61% polymorphonuclear neutrophils, and monosodium urate crystals visualized by polarizing light microscopy.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
Funding Opportunity RFA-NS-20-028 from the NIH Guide for Grants and Contracts. The purpose of this Funding Opportunity Announcement (FOA) is to solicit cooperative agreement applications that propose clinical trials to test the comparative effectiveness of existing pharmacological therapies or devices for prevention or management of pain while reducing risk of addiction. The studies must evaluate methods to manage specific pain conditions that are within the mission and research interests of participating NIH Institutes and Centers, and evaluate interventions including medications, biologics, medical and assistive devices...
Source: NIH Funding Opportunities (Notices, PA, RFA) - Category: Research Source Type: funding
ConclusionsSpinal deformity is the most common musculoskeletal manifestation of NF1. Cervical lesions are frequently asymptomatic, but patients with thoracolumbar scoliosis, dystrophic features, or a history of laminectomy should have the cervical spine carefully evaluated. For severe and progressive kyphotic deformities, most authors recommend a period of traction followed by a combined anterior-posterior fusion that is instrumented from parallel to parallel vertebra (or six or more levels). Close follow-up is very important because complications and progression are frequent.
Source: Spine Deformity - Category: Orthopaedics Source Type: research
Discussion Scoliosis is a lateral and rotational curvature of the spine from a plumb line hanging from C7 to the floor. Idiopathic scoliosis is the most common form. A review of scoliosis and its differential diagnosis can be found here. Depending on the age, 2-4% of adolescents have a positive Adams Forward Bend Test when assessed and ~2% may have idiopathic scoliosis of> 10 degrees. Curve progression relates to the magnitude of the curve and the patient’s age. Thus increased risk of progression occurs in patients with higher curvature magnitude at diagnosis, females (earlier start of puberty and therefore poss...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Abstract The authors present a case of 45-year-old man with neurofibromatosis type 1 (NF-1) and thoracic scoliosis, previously undergoing fusion surgery, who developed myelopathy. This patient further complained of lightning pain when he extended and horizontally abducted the convex-side shoulder. Radiological examination revealed the progression of dystrophic scoliosis with opened spinal canals and the presence of a neurofibroma behind the spinal cord at the apical levels. Delayed development of spinal instability can occur due to dystrophy even postoperatively in patients with NF-1. After tumor resection, he had...
Source: Journal of Orthopaedic Surgery - Category: Orthopaedics Authors: Tags: J Orthop Surg (Hong Kong) Source Type: research
Background: Cervical kyphosis may occur with neurofibromatosis type I (NF1) and is often associated with vertebral dysplasia. Outcomes of cervical spinal fusion in patients with NF1 are not well described because of the rarity of the condition. We aimed to (1) characterize the clinical presentation of cervical kyphosis and (2) report the outcomes of posterior and anteroposterior cervical fusion for the condition in these children. Methods: The medical records and imaging studies of 22 children with NF1 who had undergone spinal fusion for cervical kyphosis (mean, 67°) at a mean age of 11 years and who had been followed...
Source: JBJS - Category: Orthopaedics Authors: Tags: Pediatrics, Spine Scientific Articles Source Type: research
A 40 years old women was admitted for scoliosis for a decade, aggravated with upper back pain and dyspnea for two years. Physical examination revealed multiple cutaneous neurofibromas and café-au-lait macules. Freckling was observed in axillary region. Neurologic examination found abnormal thoracic curve and formed “Razor back” deformity. The coronal computed tomography scan showed a thoracic dextroscoliosis with rare vertebral fusion and boney obliteration penetrating the intervertebral discs between T4-T5 and T5-T6 (Figure 1).
Source: The Spine Journal - Category: Orthopaedics Authors: Tags: Images of Spine Care Source Type: research
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