{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:20:55Z","timestamp":1787772055911,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient\u2019s right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord. Surgical intervention addressed a high-flow arteriovenous fistula involving the right vertebral artery and an epidural vein, necessitating sacrifice of the artery. Posterior fusion and laminectomy were performed, resulting in stable neurological status postoperatively and significant improvement in sensory loss and weakness at three months. This case underscores the importance of a tailored posterior-only approach, involving dural fold release, to allow the spinal cord to relocate to a less tense position, thus demonstrating effective decompression in complex NF1 cases with concurrent kyphotic deformity and vertebral artery AVF.<\/jats:p>","DOI":"10.4103\/jcvjs.jcvjs_138_23","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T07:00:33Z","timestamp":1710313233000},"page":"123-126","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Correction of cervical kyphoscoliosis, bisected spinal cord, and vertebral artery to epidural vein fistula in neurofibromatosis type 1"],"prefix":"10.4103","volume":"15","author":[{"given":"Devon","family":"LeFever","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hanks","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Louie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Leveque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"R1-20240904","doi-asserted-by":"crossref","first-page":"e3292","DOI":"10.1097\/MD.0000000000003292","article-title":"Surgical treatment of dystrophic spinal curves caused by neurofibromatosis type 1: A retrospective study of 26 patients","volume":"95","author":"Zhao","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"R2-20240904","doi-asserted-by":"crossref","first-page":"e30952","DOI":"10.1097\/MD.0000000000030952","article-title":"Vertebral arteriovenous fistulae (AVF) and vertebral artery aneurysms in neurofibromatosis type 1: A case report and a systematic review","volume":"101","author":"Zhao","year":"2022","journal-title":"Medicine (Baltimore)"},{"key":"R3-20240904","doi-asserted-by":"crossref","first-page":"226","DOI":"10.11604\/pamj.2018.31.226.9797","article-title":"Dural ectasia: A manifestation of type 1 neurofibromatosis","volume":"31","author":"Derdabi","year":"2018","journal-title":"Pan Afr Med J"},{"key":"R4-20240904","doi-asserted-by":"crossref","first-page":"166","DOI":"10.2310\/6670.2010.00032","article-title":"Vertebral artery aneurysms and cervical arteriovenous fistulae in patients with neurofibromatosis 1","volume":"18","author":"Higa","year":"2010","journal-title":"Vascular"},{"key":"R5-20240904","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41394-022-00544-4","article-title":"Neurofibromatosis type 1, severe cervical spinal kyphotic deformity, and vertebral arteriovenous fistula presenting with tetraplegia: case report and literature review","volume":"8","author":"Lin","year":"2022","journal-title":"Spinal Cord Ser Cases"},{"key":"R6-20240904","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1302\/0301-620X.74B4.1624519","article-title":"Neurofibromatosis of the cervical spine. A report of eight cases","volume":"74","author":"Craig","year":"1992","journal-title":"J Bone Joint Surg Br"},{"key":"R7-20240904","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1016\/j.wneu.2017.11.174","article-title":"Comparison of outcomes in 3 surgical approaches for dystrophic cervical kyphosis in patients with neurofibromatosis 1","volume":"111","author":"Lin","year":"2018","journal-title":"World Neurosurg"},{"key":"R8-20240904","doi-asserted-by":"crossref","first-page":"e1388","DOI":"10.1016\/j.wneu.2018.11.063","article-title":"Vertebral arteriovenous fistula: A review article","volume":"122","author":"Aljobeh","year":"2019","journal-title":"World Neurosurg"},{"key":"R9-20240904","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1080\/02688697.2019.1673313","article-title":"The association of spinal deformity with dural ectasia in neurofibromatosis type 1","volume":"33","author":"Shah","year":"2019","journal-title":"Br J Neurosurg"},{"key":"R10-20240904","doi-asserted-by":"crossref","first-page":"357","DOI":"10.18071\/isz.72.0357","article-title":"Coexistence of cervical vertebral scalloping, pedicle deficiencies and dural ectasia in type I neurofibromatosis","volume":"72","author":"Yaldiz","year":"2019","journal-title":"Ideggyogy Sz"}],"container-title":["Journal of Craniovertebral Junction and Spine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_138_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:27:19Z","timestamp":1787768839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_138_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/jcvjs.jcvjs_138_23","relation":{},"ISSN":["0974-8237","0976-9285"],"issn-type":[{"value":"0974-8237","type":"print"},{"value":"0976-9285","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-10-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}