Surgical treatment of lumbosacral pseudarthrosis and spondyloptosis in a patient with neurofibromatosis type 1 and a large lumbar anterior meningocele. Case report and review of the literature.

BACKGROUND Lumbar anterior meningocele (MC) is rare in patients with neurofibromatosis type 1 (NF1). Although spinal fusion with maximum possible resection of the cele might be indicated in these special cases, reports describing operative procedures are lacking. CLINICAL PRESENTATION We present a young woman with NF1 and lower back pain due to lumbar anterior MC, extensive osteolysis, and deformation of the lumbar spine. After Harrington spondylodesis from T12 to S1 in 1989, she developed lumbosacral pseudarthrosis and transcutaneous migration of the spondylodesis. Thus the left pole of the spondylodesis was shortened below the level of L5 in 2005. Years later, the patient presented with lower back pain and wound infection. Imaging revealed the MC and avulsion of the right S1 screw with lumbosacral pseudarthrosis and spondyloptosis, and transcutaneous migration of the right spondylodesis pole. Three-stage surgery was indicated with explantation of the Harrington system in the first step and posterior fusion from T10 to S2 in the second step. Finally, vertebral resection, gathering of the cele, and implantation of a customized titanium cage was achieved through an anterior transabdominal approach. Postoperatively, the patient reported sufficient reduction of lower back pain. CONCLUSIONS Lumbar anterior MC is rare in patients with NF1 and may cause spinal instability. When surgery is indicated, long-range spinal fusion and reduction of the cele should be considered. Surgery may be challenging requiring a staged operative procedure and an interdisciplinary collaboration.