{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:16:36Z","timestamp":1780438596895,"version":"3.54.1"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Surgical management of cervical kyphosis in patients with NF-1 is a challenging task. Presently, anterior-only (AO), posterior-only (PO) and combined anterior-posterior (AP) spinal fusion are common surgical strategies. However, the choice of surgical strategy and application of Halo traction remain controversial. Few studies have shown and recommended posterior-only approach for cervical kyphosis correction in patients with NF-1. The aim of this study is to evaluate the safety and the effectiveness of halo Traction combined with posterior-only approach correction for treatment of cervical kyphosis with NF-1.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty-six patients with severe cervical kyphosis due to NF-1 were reviewed retrospectively between January 2010 and April 2018. All the cases underwent halo traction combined with posterior instrumentation and fusion surgery. Correction result, neurologic status and complications were analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In this study, cervical kyphosis Cobb angle decreased from initial 61.3\u2009\u00b1\u200919.7 degrees to postoperative 10.6\u2009\u00b1\u20093.7 degrees (P&lt;0.01), with total correction rate of 82.7%, which consist of 45.8% from halo traction and 36.9% from surgical correction. JOA scores were improved from preoperative 13.3\u2009\u00b1\u20091.6 to postoperative 16.2\u2009\u00b1\u20090.7 (P&lt;0.01). Neurological status was also improved. There was no correction loss and the neurological status was stable in mean 43\u2009months follow-up. Three patients experienced minor complications and one patient underwent a second surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Halo traction combined with PO approach surgery is safe and effective method for cervical kyphosis correction in patients with NF-1. A satisfied correction result, and successful bone fusion can be achieved via this procedure, even improvement of neurological deficits can also be obtained. Our study suggested that halo traction combined with PO approach surgery is another consideration for cervical kyphosis correction in patients with NF-1.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12891-021-04864-8","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T11:02:44Z","timestamp":1637665364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Halo traction combined with posterior-only approach correction for cervical kyphosis with Neurofibromatosis-1: minimum 2\u2009years follow-up"],"prefix":"10.1186","volume":"22","author":[{"given":"Hongqi","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaofeng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhai","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lige","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"issue":"8","key":"4864_CR1","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1007\/s00256-011-1333-x","volume":"41","author":"JL Jaremko","year":"2012","unstructured":"Jaremko JL, PJ MM, Torriani M, et al. Whole-body MRI in neurofibromatosis: incidental findings and prevalence of scoliosis. Skelet Radiol. 2012;41(8):917\u201323. https:\/\/doi.org\/10.1007\/s00256-011-1333-x.","journal-title":"Skelet Radiol"},{"issue":"8 Suppl","key":"4864_CR2","doi-asserted-by":"publisher","first-page":"S244","DOI":"10.1097\/00007632-199208001-00005","volume":"17","author":"BA Akbarnia","year":"1992","unstructured":"Akbarnia BA, Gabriel KR, Beckman E, Chalk D. Prevalence of scoliosis in neurofibromatosis. Spine (Phila Pa 1976). 1992;17(8 Suppl):S244\u20138.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"4864_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jaad.2008.12.051","volume":"61","author":"KP Boyd","year":"2009","unstructured":"Boyd KP, Korf BR, Theos A. Neurofibromatosis type 1. J Am Acad Dermatol. 2009;61(1):1\u201314; quiz 15-6. https:\/\/doi.org\/10.1016\/j.jaad.2008.12.051.","journal-title":"J Am Acad Dermatol"},{"issue":"5","key":"4864_CR4","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s00586-004-0829-7","volume":"14","author":"AI Tsirikos","year":"2005","unstructured":"Tsirikos AI, Saifuddin A, Noordeen MH. Spinal deformity in neurofibromatosis type-1: diagnosis and treatment. Eur Spine J. 2005;14(5):427\u201339. https:\/\/doi.org\/10.1007\/s00586-004-0829-7.","journal-title":"Eur Spine J"},{"issue":"9","key":"4864_CR5","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1302\/0301-620X.91B9.22101","volume":"91","author":"A Gardner","year":"2009","unstructured":"Gardner A, Millner P, Liddington M, Towns G. Translaminar screw fixation of a kyphosis of the cervical and thoracic spine in neurofibromatosis. J Bone Joint Surg Br. 2009;91(9):1252\u20135. https:\/\/doi.org\/10.1302\/0301-620X.91B9.22101.","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"4864_CR6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1055\/s-0035-1554776","volume":"6","author":"A Mesfin","year":"2016","unstructured":"Mesfin A, Bakhsh WR, Chuntarapas T, Riew KD. Cervical scoliosis: clinical and radiographic outcomes. Global Spine J. 2016;6(1):7\u201313. https:\/\/doi.org\/10.1055\/s-0035-1554776.","journal-title":"Global Spine J"},{"issue":"3","key":"4864_CR7","doi-asserted-by":"publisher","first-page":"274","DOI":"10.3171\/2012.11.SPINE12417","volume":"18","author":"S Kawabata","year":"2013","unstructured":"Kawabata S, Watanabe K, Hosogane N, et al. Surgical correction of severe cervical kyphosis in patients with neurofibromatosis type 1. J Neurosurg Spine. 2013;18(3):274\u20139. https:\/\/doi.org\/10.3171\/2012.11.SPINE12417.","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"4864_CR8","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1097\/00024720-200310000-00009","volume":"16","author":"I Yonezawa","year":"2003","unstructured":"Yonezawa I, Arai Y, Tsuji T, Takahashi M, Kurosawa H. Anterior fusion and posterior correction of severe cervical kyphosis using pedicle screw fixation in a patient with neurofibromatosis: a case report. J Spinal Disord Tech. 2003;16(5):493\u20136.","journal-title":"J Spinal Disord Tech"},{"key":"4864_CR9","doi-asserted-by":"publisher","unstructured":"Lin T, Shao W, Zhang K, Gao R, Zhou X. Comparison of outcomes in three surgical approaches for dystrophic cervical kyphosis in patients with Neurofibromatosis type. World Neurosurg. 2017. https:\/\/doi.org\/10.1016\/j.wneu.2017.11.174.","DOI":"10.1016\/j.wneu.2017.11.174"},{"issue":"3","key":"4864_CR10","doi-asserted-by":"publisher","first-page":"60","DOI":"10.13107\/jocr.2250-0685.310","volume":"5","author":"KR Choksey","year":"2015","unstructured":"Choksey KR, Modi JV. Are Two Surgeries Necessary for Correction of 1 Deformity- Cervical Kyphosis in Neurofibromatosis?- A Rare Case Report. J Orthop Case Rep. 2015;5(3):60\u20132. https:\/\/doi.org\/10.13107\/jocr.2250-0685.310.","journal-title":"J Orthop Case Rep"},{"issue":"14","key":"4864_CR11","doi-asserted-by":"publisher","first-page":"E858","DOI":"10.1097\/BRS.0b013e31824edd1c","volume":"37","author":"F Wu","year":"2012","unstructured":"Wu F, Zhang L, Liu Z, et al. Cervical neurofibromatosis with tetraplegia: management by cervical suspensory traction. Spine (Phila Pa 1976). 2012;37(14):E858\u201362. https:\/\/doi.org\/10.1097\/BRS.0b013e31824edd1c.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"4864_CR12","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/s00586-010-1602-8","volume":"20","author":"K Han","year":"2011","unstructured":"Han K, Lu C, Li J, et al. Surgical treatment of cervical kyphosis. Eur Spine J. 2011;20(4):523\u201336. https:\/\/doi.org\/10.1007\/s00586-010-1602-8.","journal-title":"Eur Spine J"},{"issue":"7","key":"4864_CR13","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.2106\/00004623-198466070-00019","volume":"66","author":"RB Winter","year":"1984","unstructured":"Winter RB. Thoracic lordoscoliosis in neurofibromatosis: treatment by a Harrington rod with sublaminar wiring. Report of two cases. J Bone Joint Surg Am. 1984;66(7):1102\u20136.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"4864_CR14","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/00002517-198801000-00006","volume":"1","author":"RB Winter","year":"1988","unstructured":"Winter RB. JE Lonstein, and M Anderson, Neurofibromatosis hyperkyphosis: a review of 33 patients with kyphosis of 80 degrees or greater. J Spinal Disord. 1988;1(1):39\u201349.","journal-title":"J Spinal Disord"},{"issue":"4","key":"4864_CR15","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1097\/01241398-199010040-00019","volume":"10","author":"JL Sirois 3rd","year":"1990","unstructured":"Sirois JL 3rd, Drennan JC. Dystrophic spinal deformity in neurofibromatosis. J Pediatr Orthop. 1990;10(4):522\u20136.","journal-title":"J Pediatr Orthop"},{"issue":"21","key":"4864_CR16","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1097\/00007632-199911010-00013","volume":"24","author":"P Parisini","year":"1999","unstructured":"Parisini P, Di Silvestre M, Greggi T, et al. Surgical correction of dystrophic spinal curves in neurofibromatosis. A review of 56 patients. Spine (Phila Pa 1976). 1999;24(21):2247\u201353.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"4864_CR17","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1302\/0301-620X.66B4.6430906","volume":"66","author":"LC Hsu","year":"1984","unstructured":"Hsu LC, Lee PC, Leong JC. Dystrophic spinal deformities in neurofibromatosis. Treatment by anterior and posterior fusion. J Bone Joint Surg Br. 1984;66(4):495\u20139.","journal-title":"J Bone Joint Surg Br"},{"issue":"3","key":"4864_CR18","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1590\/abd1806-4841.20132125","volume":"88","author":"JR Antonio","year":"2013","unstructured":"Antonio JR, Goloni-Bertollo EM, Tridico LA. Neurofibromatosis: chronological history and current issues. An Bras Dermatol. 2013;88(3):329\u201343. https:\/\/doi.org\/10.1590\/abd1806-4841.20132125.","journal-title":"An Bras Dermatol"},{"issue":"9","key":"4864_CR19","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1007\/s00198-005-1940-2","volume":"16","author":"M Lammert","year":"2005","unstructured":"Lammert M, Kappler M, Mautner VF, et al. Decreased bone mineral density in patients with neurofibromatosis 1. Osteoporos Int. 2005;16(9):1161\u20136. https:\/\/doi.org\/10.1007\/s00198-005-1940-2.","journal-title":"Osteoporos Int"},{"issue":"11","key":"4864_CR20","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/j.crad.2004.04.006","volume":"59","author":"AI Tsirikos","year":"2004","unstructured":"Tsirikos AI, Ramachandran M, Lee J, Saifuddin A. Assessment of vertebral scalloping in neurofibromatosis type 1 with plain radiography and MRI. Clin Radiol. 2004;59(11):1009\u201317. https:\/\/doi.org\/10.1016\/j.crad.2004.04.006.","journal-title":"Clin Radiol"},{"key":"4864_CR21","doi-asserted-by":"publisher","first-page":"8056273","DOI":"10.1155\/2016\/8056273","volume":"2016","author":"X Han","year":"2016","unstructured":"Han X, Sun W, Qiu Y, et al. Halo Gravity Traction Is Associated with Reduced Bone Mineral Density of Patients with Severe Kyphoscoliosis. Biomed Res Int. 2016;2016:8056273. https:\/\/doi.org\/10.1155\/2016\/8056273.","journal-title":"Biomed Res Int"},{"issue":"4","key":"4864_CR22","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s00402-017-2642-x","volume":"137","author":"S Mehrpour","year":"2017","unstructured":"Mehrpour S, Sorbi R, Rezaei R, Mazda K. Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis. Arch Orthop Trauma Surg. 2017;137(4):457\u201363. https:\/\/doi.org\/10.1007\/s00402-017-2642-x.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"8","key":"4864_CR23","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1097\/BRS.0b013e318277c874","volume":"38","author":"AG Kulkarni","year":"2013","unstructured":"Kulkarni AG, Shah SP. Intraoperative skull-femoral (skeletal) traction in surgical correction of severe scoliosis (>80\u00b0) in adult neglected scoliosis. Spine. 2013;38(8):659\u201364. https:\/\/doi.org\/10.1097\/BRS.0b013e318277c874.","journal-title":"Spine"},{"issue":"7","key":"4864_CR24","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.3760\/cma.j.issn.0366-6999.2012.07.020","volume":"125","author":"HQ Zhang","year":"2012","unstructured":"Zhang HQ, Gao QL, Ge L, et al. Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis. Chin Med J (Engl). 2012;125(7):1297\u2013302. https:\/\/doi.org\/10.3760\/cma.j.issn.0366-6999.2012.07.020.","journal-title":"Chin Med J (Engl)"},{"issue":"7","key":"4864_CR25","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1007\/s00264-010-1111-8","volume":"35","author":"HQ Zhang","year":"2011","unstructured":"Zhang HQ, Wang YX, Guo CF, et al. Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more than 100 degrees. Int Orthop. 2011;35(7):1037\u201342. https:\/\/doi.org\/10.1007\/s00264-010-1111-8.","journal-title":"Int Orthop"},{"issue":"9","key":"4864_CR26","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1097\/Brs.0b013e31816c8b17","volume":"33","author":"A Hamzaoglu","year":"2008","unstructured":"Hamzaoglu A, Ozturk C, Aydogan M, et al. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (> 100 degrees). Spine. 2008;33(9):979\u201383. https:\/\/doi.org\/10.1097\/Brs.0b013e31816c8b17.","journal-title":"Spine"},{"issue":"5","key":"4864_CR27","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1227\/00006123-199411000-00025","volume":"35","author":"BA Ward","year":"1994","unstructured":"Ward BA, Harkey HL, Parent AD, RA MG Jr, Kendig RJ. Severe cervical kyphotic deformities in patients with plexiform neurofibromas: case report. Neurosurgery. 1994;35(5):960\u20134 discussion 964.","journal-title":"Neurosurgery"},{"issue":"1 Supp1 1","key":"4864_CR28","doi-asserted-by":"publisher","first-page":"S90","DOI":"10.1227\/01.NEU.0000215553.49728.B0","volume":"60","author":"MP Steinmetz","year":"2007","unstructured":"Steinmetz MP, Stewart TJ, Kager CD, Benzel EC, Vaccaro AR. Cervical deformity correction. Neurosurgery. 2007;60(1 Supp1 1):S90\u20137. https:\/\/doi.org\/10.1227\/01.NEU.0000215553.49728.B0.","journal-title":"Neurosurgery"},{"issue":"1","key":"4864_CR29","doi-asserted-by":"publisher","first-page":"95","DOI":"10.4103\/0019-5413.54968","volume":"44","author":"W Laohacharoensombat","year":"2010","unstructured":"Laohacharoensombat W, Wajanavisit W, Woratanarat P. Cervical neurofibromatosis with quadriparesis: management by fibular strut graft. Indian J Orthop. 2010;44(1):95\u20137. https:\/\/doi.org\/10.4103\/0019-5413.54968.","journal-title":"Indian J Orthop"},{"issue":"1","key":"4864_CR30","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3171\/2010.9.SPINE091015","volume":"14","author":"J Ma","year":"2011","unstructured":"Ma J, Wu Z, Yang X, Xiao J. Surgical treatment of severe cervical dystrophic kyphosis due to neurofibromatosis type 1: a review of 8 cases. J Neurosurg Spine. 2011;14(1):93\u20138. https:\/\/doi.org\/10.3171\/2010.9.SPINE091015.","journal-title":"J Neurosurg Spine"},{"key":"4864_CR31","doi-asserted-by":"publisher","first-page":"e1190","DOI":"10.1016\/j.wneu.2019.04.096","volume":"127","author":"J Wang","year":"2019","unstructured":"Wang J, Liu C, Wang C, et al. Early and midterm outcomes of surgical correction for severe dystrophic cervical kyphosis in patients with Neurofibromatosis type 1: a retrospective multicenter study. World Neurosurg. 2019;127:e1190\u2013200. https:\/\/doi.org\/10.1016\/j.wneu.2019.04.096.","journal-title":"World Neurosurg"},{"issue":"3","key":"4864_CR32","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00264-018-4050-4","volume":"43","author":"G Yifei","year":"2019","unstructured":"Yifei G, Xiaolong S, Yang L, Peng C, Wen Y. Clinical outcomes of anterior correction and reconstruction for neurofibromatosis-associated severe cervical kyphotic deformity. Int Orthop. 2019;43(3):639\u201346. https:\/\/doi.org\/10.1007\/s00264-018-4050-4.","journal-title":"Int Orthop"},{"issue":"21","key":"4864_CR33","doi-asserted-by":"publisher","first-page":"e95","DOI":"10.2106\/JBJS.16.00096","volume":"98","author":"IJ Helenius","year":"2016","unstructured":"Helenius IJ, Sponseller PD, Mackenzie W, et al. Outcomes of Spinal Fusion for Cervical Kyphosis in Children with Neurofibromatosis. J Bone Joint Surg Am. 2016;98(21):e95. https:\/\/doi.org\/10.2106\/JBJS.16.00096.","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"4864_CR34","doi-asserted-by":"publisher","first-page":"557","DOI":"10.2176\/nmc.ra.2014-0421","volume":"55","author":"K Ito","year":"2015","unstructured":"Ito K, Aoyama T, Miyaoka Y, Horiuchi T, Hongo K. Surgical strategies for cervical spinal Neurinomas. Neurol Med Chir (Tokyo). 2015;55(7):557\u201363. https:\/\/doi.org\/10.2176\/nmc.ra.2014-0421.","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"4864_CR35","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s13018-015-0280-y","volume":"10","author":"KT Yeh","year":"2015","unstructured":"Yeh KT, Lee RP, Chen IH, et al. Laminoplasty instead of laminectomy as a decompression method in posterior instrumented fusion for degenerative cervical kyphosis with stenosis. J Orthop Surg Res. 2015;10:138. https:\/\/doi.org\/10.1186\/s13018-015-0280-y.","journal-title":"J Orthop Surg Res"},{"issue":"7","key":"4864_CR36","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1302\/0301-620X.96B7.33665","volume":"96-B","author":"JZ Guzman","year":"2014","unstructured":"Guzman JZ, Baird EO, Fields AC, et al. C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature. Bone Joint J. 2014;96-B(7):950\u20135. https:\/\/doi.org\/10.1302\/0301-620X.96B7.33665.","journal-title":"Bone Joint J"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04864-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-021-04864-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04864-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T11:04:22Z","timestamp":1637665462000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-021-04864-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,23]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4864"],"URL":"https:\/\/doi.org\/10.1186\/s12891-021-04864-8","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,23]]},"assertion":[{"value":"9 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Our research was approved by the ethics department of Xiangya Hospital, Changsha. We have consensus with all participants. We also followed the Declaration of Helsinki and relevant policies in China. Written informed consent was acquired from each of the patients (or their parents and legal guardians) to authorize treatment, imageology findings, and photographic documentation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was acquired from each of the patients (or their parents and legal guardians) to authorize treatment, imageology findings, and photographic documentation. The patients (or their parents and legal guardians) consented to the publication of their pictures as well as their anonymous and clustered data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"973"}}