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Kyphectomy in Children with Myelomeningocele

  • Symposium: Myelomeningocele
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patients with myelomeningocele and rigid lumbar and thoracolumbar kyphosis face substantial functional difficulties with sitting and lying supine and are prone to skin breakdown over the gibbus and risk of infection. Kyphectomy, along with cordotomy and segmental spinal instrumentation down to the pelvis, is one alternative that can provide reliable correction of the deformity but also can maintain that correction over a period of time.

Questions/purposes

We determined the fusion rates, deformity correction and maintenance, and perioperative complications of kyphectomy with long segmental spinal instrumentation using the Warner and Fackler technique.

Methods

We retrospectively reviewed the charts and radiographs of 33 patients with myelomeningocele who had kyphectomy with segmental spinal instrumentation down to the pelvis between 1991 and 2006. The average age at surgery was 7.6 years (range, 3–19 years). Twenty-one patients had a minimum 2-year followup (average, 7.0 years; range, 2.4–15.7 years).

Results

The average preoperative kyphosis of 124° (range, 75°–210°) improved at last followup to 22° (range, 3°–55°) with an average correction of 81% (range, 59%–98%). We identified 17 postoperative complications. Wound and skin complications were most common; 11 secondary surgeries were performed in 10 patients.

Conclusions

Surgery for myelomeningocele kyphosis is technically demanding and carries substantial risk. Kyphectomy and posterior spinal fusion and instrumentation with the Warner and Fackler technique allow correction and maintenance of sagittal alignment.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Akbar M, Bremer R, Thomsen M, Carstens C, Abel R. Kyphectomy in children with myelodysplasia: results 1994–2004. Spine (Phila Pa 1976). 2006;31:1007–1013.

    Google Scholar 

  2. Banta JV. Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine (Phila Pa 1976). 1990;15:946–952.

    CAS  Google Scholar 

  3. Banta JV, Hama JS. Natural history of the kyphotic deformity in myelomeningocele. J Bone Joint Surg Am. 1976;55:279.

    Google Scholar 

  4. Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second look at lumbar fusions. Spine (Phila Pa 1976). 1993;18:1186–1189.

    CAS  Google Scholar 

  5. Carman DL, Browne RH, Birch JG. Measurements of scoliosis and kyphosis radiographs: interobserver and intraobserver variation. J Bone Joint Surg Am. 1990;72:328–333.

    PubMed  CAS  Google Scholar 

  6. Carstens C, Koch H, Brocal DR, Niethard FU. Development of pathological lumbar kyphosis in myelomeningocele. J Bone Joint Surg Br. 1996;78:945–950.

    Article  PubMed  CAS  Google Scholar 

  7. Christensen FB, Laursen M, Gelineck J, Eiskjaer SP, Thomsen K, Bunger CE. Interobserver and intraobserver agreement of radiograph interpretation with and without pedicle screw implants: the need for a detailed classification system in posterolateral spinal fusion. Spine (Phila Pa 1976). 2001;26:538–544.

    CAS  Google Scholar 

  8. Christofersen MR, Brooks AL. Excision and wire fixation of rigid myelomeningocele kyphosis. J Pediatr Orthop. 1985;5:691–696.

    Article  PubMed  CAS  Google Scholar 

  9. Doers T, Walker JL, van den Brink KD, Stevens DB, Heavilon J. The progression of untreated lumbar kyphosis and the compensatory thoracic lordosis in myelomeningocele. Dev Med Child Neurol. 1997;39:326–330.

    PubMed  CAS  Google Scholar 

  10. Hamill CL, Simmons ED. Interobserver variability in grading lumbar fusions. J Spinal Disord. 1997;10:387–390.

    Article  PubMed  CAS  Google Scholar 

  11. Heydemann JS, Gillespie R. Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation. Spine (Phila Pa 1976). 1987;12:37–41.

    CAS  Google Scholar 

  12. Huang TJ, Lubicky JP. Kyphectomy and segmental instrumentation in young children with myelomeningocele kyphosis. J Formos Med Assoc. 1994;93:503–508.

    PubMed  CAS  Google Scholar 

  13. Johnson JTH, Southwick WO. Bone growth after spine fusion: A clinical survey. J Bone Joint Surg Am. 1960;42:1396–1412.

    Google Scholar 

  14. Kadic MA, Verbout AJ. Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods. Acta Orthop Belg. 1991;57:45–51.

    PubMed  CAS  Google Scholar 

  15. Ko AL, Song K, Ellenbogen RG, Avellino AM. Retrospective review of multilevel spinal fusion combined with spinal cord transection for treatment of kyphoscoliosis in pediatric myelomeningocele patients. Spine (Phila Pa 1976). 2007;32:2493–2501.

    Google Scholar 

  16. Leatherman KD, Dickson RA. Congenital kyphosis in myelomeningocele: vertebral body resection and posterior spine fusion. Spine (Phila Pa 1976). 1978;3:222–226.

    CAS  Google Scholar 

  17. Lindseth RE. Spine deformity in myelomeningocele. Instr Course Lect. 1991;40:273–279.

    Google Scholar 

  18. Lindseth RE, Stelzer L. Vertebral excision for kyphosis in children with myelomeningocele. J Bone Joint Surg Am. 1979;61:699–704.

    PubMed  CAS  Google Scholar 

  19. Lintner SA, Lindseth RE. Kyphotic deformity in patients who have myelomeningocele: operative treatment and long-term follow-up. J Bone Joint Surg Am. 1994;76:1301–1307.

    PubMed  CAS  Google Scholar 

  20. Majd ME, Richey JL, Holt RT. Treatment of spinal deformities in myelodysplasia: lumbar kyphectomy. Spine: State of the Art Reviews. 1998;12:91–102.

    Google Scholar 

  21. Martin J Jr, Kumar SJ, Guille JT, Ger D, Gibbs M. Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment. J Pediatr Orthop. 1994;14:323–328.

    Article  PubMed  Google Scholar 

  22. McCall R. Modified Luque instrumentation after myelomeningocele kyphectomy. Spine (Phila Pa 1976). 1998;23:1406–1411.

    CAS  Google Scholar 

  23. McCarthy RE, Dunn H, McCullough FL. Luque fixation to the sacral ala using the Dunn-McCarthy modification. Spine (Phila Pa 1976). 1989;14:281–283.

    CAS  Google Scholar 

  24. McMaster MJ. The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele. Spine (Phila Pa 1976). 1988;13:417–424.

    CAS  Google Scholar 

  25. Mintz LJ, Sarwark JF, Dias LS, Schafer MF. The natural history of congenital kyphosis in myelomeningocele: a review of 51 children. Spine (Phila Pa 1976). 1991;16:S348–S350.

    CAS  Google Scholar 

  26. Niall DM, Dowling FE, Fogarty EE, Moore DP, Goldberg C. Kyphectomy in children with myelomeningocele: a long-term outcome study. J Pediatr Orthop. 2004;24:37–44.

    Article  PubMed  CAS  Google Scholar 

  27. Nolden MT, Sarwark JF, Vora A, Grayhack JJ. A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis. Spine (Phila Pa 1976). 2002;27:1807–1813.

    Google Scholar 

  28. Sarwark JF. Kyphosis deformity in myelomeningocele. Orthop Clin North Am. 1999;30:451–455.

    Article  PubMed  CAS  Google Scholar 

  29. Sharrard WJ. Spinal osteotomy for congenital kyphosis in myelomeningocele. J Bone Joint Surg Br. 1968;50:466–471.

    PubMed  CAS  Google Scholar 

  30. Sharrard WJ, Drennan JC. Osteotomy-excision of the spine for lumbar kyphosis in older children with myelomeningocele. J Bone Joint Surg Br. 1972;54:50–60.

    PubMed  CAS  Google Scholar 

  31. Sriram K, Babchenko WP, Hall JE. Surgical management of spinal deformities in spina bifida. J Bone Joint Surg Br. 1972;54:666–676.

    PubMed  CAS  Google Scholar 

  32. Stotts AK, Smith JT, Santora SD, Roach JW, D’Astous JL. Measurement of spinal kyphosis: implications for the management of Scheuermann`s kyphosis. Spine (Phila Pa 1976). 2002;27:2143–2146.

    Google Scholar 

  33. Thomsen MD, Lang RD, Carstens C. Results of kyphectomy with the technique of Warner and Fackler in children with myelodysplasia. J Pediatr Orthop B. 2000;9:143–147.

    PubMed  CAS  Google Scholar 

  34. Torode I, Godette G. Surgical correction of congenital kyphosis in myelomeningocele. J Pediatr Orthop. 1995;15:202–205.

    PubMed  CAS  Google Scholar 

  35. Warner WC, Fackler CD. Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodysplasia. J Pediatr Orthop. 1993;13:704–708.

    Article  PubMed  Google Scholar 

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Acknowledgment

We thank John P. Lubicky, MD, former chief of staff at Shriners Hospital for Children–Chicago and one of the two senior surgeons.

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Authors and Affiliations

  1. Department of Orthopaedics, Shriners Hospital for Children–Chicago, 2211 North Oak Park Avenue, Chicago, IL, 60707, USA

    Haluk Altiok MD, Craig Finlayson MD, Sahar Hassani MS & Peter Sturm MD

  2. Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA

    Haluk Altiok MD

  3. Department of Orthopaedics, Loyola University Medical Center, Maywood, IL, USA

    Peter Sturm MD

Authors
  1. Haluk Altiok MD
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  2. Craig Finlayson MD
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  3. Sahar Hassani MS
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  4. Peter Sturm MD
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Corresponding author

Correspondence to Haluk Altiok MD.

Additional information

One of the authors (PS) is a consultant for DePuy Spine (Raynham, MA) and Pioneer Surgical Technology (Marquette, MI) and a stockholder/shareholder for Pioneer Surgical Technology.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Altiok, H., Finlayson, C., Hassani, S. et al. Kyphectomy in Children with Myelomeningocele. Clin Orthop Relat Res 469, 1272–1278 (2011). https://doi.org/10.1007/s11999-010-1641-9

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  • DOI: https://doi.org/10.1007/s11999-010-1641-9

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