Abstract
Background: Intraspinal rib head dislocation is a known consequence of dystrophic scoliosis associated with neurofibromatosis type 1 (NF-1), with limited consensus regarding optimal management.
Methods: A systematic review was conducted of literature pertaining to intraspinal rib head dislocation in the setting of dystrophic scoliosis in NF-1 from 1986 to 2026. Due to heterogeneity of reporting of the collected material, a descriptive analysis was performed for patients who underwent rib head resection and those who did not undergo rib head resection.
Results: A total of 22 studies involving 128 patients and published between 1986 and 2026 were evaluated. The mean ± standard deviation age of the included patients was 12.63 ± 6.28 years. Rib head resection status was clearly reported in 126 patients; 28 patients underwent rib head resection, while 98 patients were managed without rib head resection. One patient underwent partial rib resection, and 1 patient underwent nonsurgical management. Management varied between studies. Posterior instrumentation was the most commonly used surgical strategy, using traditional growing rods, pedicle screw constructs, or hybrid systems. Osteotomies were included as part of deformity correction in selected patients. Both Rib head resection and nonresection strategies were used across studies. Neurological improvement was reported in 14 of 14 neurologically involved patients with available outcome data. Radiological improvement was observed after surgery, with mean coronal Cobb correction of 31.22 degrees, corresponding to 45.43% correction, and mean thoracic kyphosis correction of 27.76 degrees, corresponding to 44.65% correction. The most frequently reported postoperative complication was pedicle screw malposition, followed by distal screw loosening and implant-related complications.
Conclusions: Intraspinal rib head dislocation requires individualized management depending on age, severity of deformity, and clinical presentation. Both Rib head resection and nonresection strategies have been reported with favorable outcomes in selected patients. However, evidence remains limited by small sample sizes, heterogeneous reporting, and baseline differences between groups.
