Neurofibromatosis type I: clinical and imaging features of Von Recklinghausen's disease.

OBJECTIVE

To discuss the case of a 45-year-old woman, with a prior diagnosis of neurofibromatosis type 1 (NF-1), complaining of low back and cervical spine pain with bilateral upper extremity paresthesias.

CLINICAL FEATURES: The patient had a dull, achy, constant low-back pain of 4 months' duration, with mild headaches and upper extremity paresthesias. Multiple skin lesions and spinopelvic postural imbalances were present. Diagnostic radiography, along with advanced imaging, demonstrated multilevel dysplastic osseous changes, with dural ectasia, scoliosis, and tumor extension. In addition to the previous diagnosis of NF-1, our clinical diagnosis included segmental dysfunction with resultant cervicalgia, lumbalgia, and myospasm.

INTERVENTION AND OUTCOME: Treatment consisted of a course of spinal manipulation of the lumbopelvic region, with adjunctive therapy consisting of interferential therapy, heat, and rehabilitative exercise. Marked reduction in pain and paresthesia with improved function were achieved.

CONCLUSIONS

NF-1 is a multisystem disease with neoplasia of the skin and nervous system. Patients experience a lifetime of morbidity and increased risk of mortality, depending on the extent of the disease. A multitude of therapeutic regimens may be engaged to improve NF-1-associated symptomatology and morbidity. Chiropractic spinal manipulation may have a positive effect in pain reduction and improved function in patients who have NF-1 without spinal instability.