Precision Restoration of Complex Cervical Instability and Decompression for Neurofibromatosis Type I: A Case Report Using Patient-Specific 3D-Printed Templates

Zekai Ma^1,2Weipeng Zheng²Ning Wang²Li Ruicong^2,3Shifeng Wen^2*

• ¹Guangdong Medical University, Zhanjiang, China
• ²Guangzhou First People's Hospital, Guangzhou, China
• ³Guangzhou Medical University, Guangzhou, China

Severe cervical kyphosis concurrent with neurofibromatosis type 1 (NF-1) and large intraspinal tumors presents a dual challenge of oncological control and biomechanical reconstruction. We report a rare case of a 14-year-old male with NF-1 secondary to C1-C6 cervical spondylolisthesis, cervical retroversion, retrolisthesis of the C3 vertebral body (less than 1/2 of the vertebral diameter), C2 dislocation, atlantoaxial rotational dislocation, and a large intradural tumor, which caused acute spinal cord compression and neurofunctional deficits. An integrated surgical strategy combining microsurgical tumor resection with 3D-printed corrective fusion was implemented. Intraoperatively, gross total resection (GTR) of the tumor was achieved, followed by precise pedicle screw fixation assisted by patient-specific 3D-printed guides. This comprehensive approach prevented further neurological damage, and the patient achieved satisfactory clinical outcomes postoperatively. NF-1 is an autosomal dominant genetic disorder with an incidence of 1/3000–1/4000, characterized by diverse manifestations including skin abnormalities, neurological tumors, and musculoskeletal abnormalities. Approximately 50% of cases arise from de novo mutations.