Rib head dislocation causing spinal canal stenosis in a chil
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Case Report: A 10-year-old female with neurofibromatosis, type 1 (NF-1) and severe dystrophic scoliosis presented with progressive difficulty to ambulate due to lower back pain for two months. There were no reported neurological symptoms, such as numbness or incontinence.

Initial radiograph of the spine demonstrated the patient’s severe dextroscoliotic curve with a Cobb angle measurement of 81 degrees measured from the superior endplate of T7 to the inferior endplate of T11. Cross-sectional imaging workup began noncontrast MRI of the spine, which most notably demonstrated dislocated right posterior tenth and eleventh ribs through their corresponding neuroforamina. The protruded ribs were not causing cord compression but were indenting the thecal sac. Paraspinal neurofibromas and dural ectasia were appreciated at multiple levels. The MRI also depicted the extent of plexiform neurofibromas along the contour of the posterior right 9th through 12th ribs. No clear consensus has been made regarding surgical management. Thus, it is rendered on a case-by-case basis. With the review of previous cases, rib head excision has been consistently favored in the surgical management, since it was first thought that the rib head could disturb the cord in the process of correcting the kyphoscoliosis. There have been case reports of postoperative rib head dislocation in NF-1 patients who have developed paraparesis after posterior spinal fusion without prior recognition.

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