Costotransverse screws for the treatment of dystrophic thoracic rotatory dislocation: illustrative case

Dystrophic deformities in neurofibromatosis type 1 progress relentlessly. If left untreated, they may lead to neurological impairment. Routine stabilization methods are often not feasible at the dystrophic levels. Circumferential arthrodesis has historically been recommended to reduce the risk of pseudarthrosis.

A 14-year-old female presented with progressive kyphoscoliosis resulting in T2-3 rotatory dislocation without neurological deficits. She underwent posterior-only cervicothoracic arthrodesis with bone grafting. Thoracic fixation was achieved exclusively using costotransverse screws. Solid fusion was confirmed by a CT study 8 months postoperatively; therefore, no additional procedures were performed to augment the fusion. The anterior approach was avoided to prevent the associated morbidity. At the 21-month follow-up visit, the patient was asymptomatic, with no change in her neurological status and no progression of the deformity. At 8 years postoperatively, she did not require further surgical intervention and reported mild intermittent pain.

In selected patients, costotransverse screws may provide safe and effective anchor points during posterior arthrodesis of dystrophic rotatory dislocations. https://thejns.org/doi/10.3171/CASE26213.