Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan

To evaluate the radiographic and clinical outcomes of dystrophic neurofibromatosis type 1 (NF1) kyphoscoliosis patients undergoing three-column osteotomy (3CO), halo-gravity traction (HGT), or posterior column osteotomy (PCO), assessing their efficacy and safety. Patients were categorized into 3CO, HGT, and PCO groups based on surgical strategy. Radiographic parameters were measured preoperatively, postoperatively, and at follow-ups. Intraoperative and postoperative complications were recorded, and patient-reported outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire. A total of 126 patients were included (9 in 3CO, 22 in HGT, 95 in PCO). Significant differences were observed in age (p = 0.001), operation time (p = 0.011), estimated blood loss (p = 0.003), and satellite rod techniques (p = 0.013). Preoperative Cobb angles were 84.3° (3CO), 99.1° (HGT), and 60.0° (PCO). Postoperative improvements were significant in Cobb angles, apical vertebral translation, segmental kyphosis, and deformity angular ratio (p < 0.001), with no significant correction loss at follow- up. Complications were reported in 3CO (n=6), HGT (n=13), and PCO (n=40). PCO, 3CO, and HGT are viable options for dystrophic NF1 kyphoscoliosis correction. While all approaches showed significant improvements, 3CO was associated with increased perioperative complications.