, Volume 469, Issue 5, pp 1272-1278
Date: 19 Oct 2010

Kyphectomy in Children with Myelomeningocele

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

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.