Surgical complications of kyphoscoliosis secondary to neurofibromatosis type 1: a systematic review

Given the high complication rates associated with surgical correction of neurofibromatosis type 1 (NF-1)-related kyphoscoliosis, this systematic review aimed to quantify the incidence and types of perioperative complications and analyze risk-modifying factors, including surgical approach, deformity characteristics, and follow-up duration, in hopes of providing evidence-based recommendations for surgical planning.A systematic review was conducted according to the latest Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Articles published in Medline, Embase, and Web of Science up to March 2024 were searched using the keywords "neurofibromatosis type 1," "spinal deformity," "scoliosis," "kyphosis," and "kyphoscoliosis."Intraoperative and postoperative complications were then systematically collected and analyzed.Subgroup analyses were conducted according to surgical strategy, surgical approach, deformity location, and follow-up duration.A total of 43 studies, encompassing 1,157 patients, met the inclusion criteria.The overall complication rate was 34.8% (403/1,157 patients).Among all reported complications, alignment-related and instrumentation-related complications accounted for 30.0%(121/403) and 25.3% (102/403), respectively.Although the growing-rod strategy preserved spinal growth, it was associated with a greater risk of complications than was the bone graft fusion strategy (54.3% vs. 30.6%,p<0.01).The total complication rate was higher with combined anterior-posterior approaches than with posterior-only approaches (36.1% vs. 15.1%,p<0.01).Surgeries for cervical kyphosis had a higher complication rate (35.8%) than did those for thoracolumbar deformities (20.9%).Additionally, patients with longer follow-up durations (>5 years) showed a higher incidence of minor complications than did those with shorter follow-up durations (35.6% vs. 27.0%,p=0.04).Surgical treatment of NF-1-related kyphoscoliosis carries a high risk of complications, which are influenced by surgical approach, deformity location, and follow-up duration.Strategies such as preoperative traction, intraoperative neuromonitoring, and optimized fixation techniques may help reduce risks.Future research should focus on refining surgical strategies and developing novel biomaterials to improve long-term outcomes.