Zoledronic acid in the treatment of severe scoliosis associated with neurofibromatosis type 1 (NF1): a case report.

INTRODUCTION AND

IMPORTANCE

We report the first case of perioperative zoledronic acid administration in an adolescent with neurofibromatosis type 1 (NF1) complicated by severe scoliosis. This case provides a hypothesis-generating experience for bone turnover screening and bisphosphonate intervention in the management of NF1-related scoliosis.

PRESENTATION OF CASE: First case report: adolescent NF1 with severe scoliosis treated by perioperative zoledronic acid plus halo-pelvic traction and spinal fusion. The regimen included preoperative daily traction and 4 mg zoledronic acid, followed by postoperative spinal fusion and 1 mg zoledronic acid. Traction improved spinal alignment and pulmonary function. Bone turnover markers decreased after zoledronic acid administration.

CLINICAL DISCUSSION: For the first time, zoledronic acid was administered perioperatively during primary spinal fusion in an adolescent patient with NF1. Bone turnover markers were reduced after zoledronic acid administration, and a temporal decrease in bone turnover was observed during traction and after surgery. The combination of traction and zoledronic acid was associated with favorable bone marker changes in this patient. A preliminary, hypothesis-generating bone management algorithm is proposed based on this single case: screen for bone markers and spinal CT in patients with severe NF1-associated scoliosis; if high bone turnover or low CT values are detected, consider zoledronic acid administration prior to traction.

CONCLUSION

In this adolescent patient with NF1-associated severe scoliosis, perioperative zoledronic acid combined with traction and spinal fusion was associated with reduced bone turnover markers and stable implant fixation at a 12-month follow-up. This strategy may provide a hypothesis-generating option for perioperative bone health management. Further large, controlled studies are needed to confirm its efficacy and safety.