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Myelomeningocele

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The Growing Spine

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Abstract

Myelomeningocele is a congenital pathologic condition characterized by a defect in the posterior vertebral elements, a malformation in the underlying neural elements, a related neurologic deficit, and the related multi-system consequences of the resulting paralysis. Spinal deformity of some degree will occur in most involved individuals, but unlike the deformities in most other neuromuscular diseases, its cause is variable and, in some cases, progression preventable. The spinal deformity may be congenital, or developmental due to paralysis or bony deficiency. It may also be secondary to associated abnormalities that include Arnold–Chiari malformation, hydrocephalus, spinal cord tethering, and syringomyelia. Most children with myelomeningocele will have some form of spinal cord tethering and current data supports an aggressive surgical approach to this condition when it is symptomatic. Additional unique features include frequent allergy to latex, precocious puberty, and the apparent increased incidence in mothers with folate deficiency.

Surgery is the definitive treatment of spinal deformity that either is or is predicted to become symptomatic. The procedures have a significant risk due to the anatomic abnormalities of the spine and the orthopedic, neurologic, and medical comorbidities. The preoperative evaluation must address the associated problems that may adversely affect outcomes such as urinary tract infections, poor nutrition, untreated hydrocephalus, symptomatic spinal cord tethering, and scarred or compromised skin and soft tissues. Segmental spinal instrumentation represents a significant technical improvement. It permits stable fixation of the dysplastic posterior elements, improved deformity correction, and earlier mobilization. Growth preserving technology offer another option for the treatment of significant early onset spinal deformity. Techniques that avoid midline approaches seem particularly suitable to this population.

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References

  1. Abol ON, Stuecker R (2014) Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular scoliosis: a preliminary report. Spine J 14(7):1183–1191

    Google Scholar 

  2. Ahmad AA (2013) Treatment of spinal deformity associated with myelomeningocele in growing children with the use of the four-rib construct. J Pediatr Orthop B 22(6):595–601

    Article  PubMed  Google Scholar 

  3. Ajeena AW, Hall IE, Emans JB (1993) Functional outcomes in myelodysplasia following spinal fusion. Orthop Trans 17:107

    Google Scholar 

  4. Allen BL Jr, Ferguson RL (1979) The operative treatment of myelomeningocele spinal deformity—1979. Orthop Clin North Am 10:845–862

    PubMed  Google Scholar 

  5. Allen BL Jr, Ferguson RL (1982) The Galveston technique for L rod instrumentation of the scoliotic spine. Spine 7:276–284

    Article  PubMed  Google Scholar 

  6. Asher M, Olson J (1983) Factors affecting the ambulatory status of patients with spina bifida cystica. J Bone Joint Surg Am 65:350–356

    CAS  PubMed  Google Scholar 

  7. Banta JV (1990) Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine 15:946–952

    Article  CAS  PubMed  Google Scholar 

  8. Banta JV (1996) The orthopaedic history of spinal dysraphism. I: the early history. Dev Med Child Neurol 38:848–854

    Article  CAS  PubMed  Google Scholar 

  9. Banta JV (2003) Cerebral palsy, myelomeningocele, hydrosyringomyelia, Rett syndrome, and muscular dystrophy. In: DeWald RL, Arlet V, Carl A, O'Brien MF (eds) Spinal deformities: the comprehensive text. Thieme, NT, New York, pp 316–326

    Google Scholar 

  10. Banta JV, Bonanni C, Prebluda J (1993) Latex anaphylaxis during spinal surgery in children with myelomeningocele. Dev Med Child Neurol 35:543–548

    Article  CAS  PubMed  Google Scholar 

  11. Banta JV, Park SM (1983) Improvement in pulmonary function in patients having combined anterior and posterior spine fusion for myelomeningocele scoliosis. Spine 8:765–770

    Article  CAS  PubMed  Google Scholar 

  12. Basobas L, Mardjetko S, Hammerberg K, Lubicky J (2003) Selective anterior fusion and instrumentation for the treatment of neuromuscular scoliosis. Spine 28:S245–S248

    Article  PubMed  Google Scholar 

  13. Benson ER, Thomson JD, Smith BG, Banta JV (1998) Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine 23:2308–2317; discussion 2318

    Article  CAS  PubMed  Google Scholar 

  14. Birmingham PK, Suresh S (1999) Latex allergy in children: diagnosis and management. Indian J Pediatr 66:717–724

    Article  CAS  PubMed  Google Scholar 

  15. Boachie-Adjei O, Lonstein JE, Winter RB, Koop S, vanden Brink K, Denis F (1989) Management of neuromuscular spinal deformities with Luque segmental instrumentation. J Bone Joint Surg Am 71:548–562

    CAS  PubMed  Google Scholar 

  16. Brinker MR, Rosenfeld SR, Feiwell E, Granger SP, Mitchell DC, Rice JC (1994) Myelomeningocele at the sacral level. Long-term outcomes in adults. J Bone Joint Surg Am 76:1293–1300

    CAS  PubMed  Google Scholar 

  17. Brophy JD, Sutton LN, Zimmerman RA, Bury E, Schut L (1989) Magnetic resonance imaging of lipomyelomeningocele and tethered cord. Neurosurgery 25:336–340

    Article  CAS  PubMed  Google Scholar 

  18. Campbell, R Jr, Smith M, Allen W et al (1980) The treatment of secondary thoracic insufficiency syndrome of myelomeningocele by a hybrid VEPTR “Eiffel Tower” construct with s-hook iliac crest pedestal fixation. Pediatric Orthopaedic Society of North America Annual Meeting, Albuquerque

    Google Scholar 

  19. Carstens C, Paul K, Niethard FU, Pfeil J (1991) Effect of scoliosis surgery on pulmonary function in patients with myelomeningocele. J Pediatr Orthop 11:459–464

    Article  CAS  PubMed  Google Scholar 

  20. Cochrane DD, Finley C, Kestle J, Steinbok P (2000) The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10(Suppl 1):13–17

    Article  PubMed  Google Scholar 

  21. Cremer R, Hoppe A, Kleine-Diepenbruck U, Blaker F (1998) Longitudinal study on latex sensitization in children with spina bifida. Pediatr Allergy Immunol 9:40–43

    Article  CAS  PubMed  Google Scholar 

  22. DeWald RL, Faut MM (1979) Anterior and posterior spinal fusion for paralytic scoliosis. Spine 4:401–409

    Article  CAS  PubMed  Google Scholar 

  23. Di Rocco CRM (1989) Chiari malformations. In: Raimondi AJ, Choux M, DiRocco C (eds) The pediatric spine: developmental anomalies. Springer, New York, pp 57–90

    Chapter  Google Scholar 

  24. Drummond D, Breed AL, Narechania R (1985) Relationship of spine deformity and pelvic obliquity on sitting pressure distributions and decubitus ulceration. J Pediatr Orthop 5:396–402

    Article  CAS  PubMed  Google Scholar 

  25. Drummond D, Guadagni J, Keene JS, Breed A, Narechania R (1984) Interspinous process segmental spinal instrumentation. J Pediatr Orthop 4:397–404

    Article  CAS  PubMed  Google Scholar 

  26. Ferguson RL, Allen BL Jr (1983) Staged correction of neuromuscular scoliosis. J Pediatr Orthop 3:555–562

    Article  CAS  PubMed  Google Scholar 

  27. Flippin MA, Canale S, Akbarnia BA (2008) Spinal deformity in myelomeningocele. In: Kim D, Betz R (eds) Surgery of the pediatric spine. Thieme, New York, pp 467–477

    Google Scholar 

  28. Furman L, Mortimer JC (1994) Menarche and menstrual function in patients with myelomeningocele. Dev Med Child Neurol 36:910–917

    Article  CAS  PubMed  Google Scholar 

  29. Gau YL, Lonstein JE, Winter RB, Koop S, Denis F (1991) Luque–Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients. J Spinal Disord 4:399–410

    Article  CAS  PubMed  Google Scholar 

  30. Geiger F, Parsch D, Carstens C (1999) Complications of scoliosis surgery in children with myelomeningocele. Eur Spine J 8:22–26

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Gentili A, Lima M, Ricci G, Pigna A, Fae M, Di Lorenzo E, Masi M, Baroncini S (2006) Secondary prevention of latex allergy in children: analysis of results. Pediatr Med Chir 28:83–90

    CAS  PubMed  Google Scholar 

  32. Gerber AC, Jorg W, Zbinden S, Seger RA, Dangel PH (1989) Severe intraoperative anaphylaxis to surgical gloves: latex allergy, an unfamiliar condition. Anesthesiology 71:800–802

    Article  CAS  PubMed  Google Scholar 

  33. Gold M, Swartz JS, Braude BM, Dolovich J, Shandling B, Gilmour RF (1991) Intraoperative anaphylaxis: an association with latex sensitivity. J Allergy Clin Immunol 87:662–666

    Article  CAS  PubMed  Google Scholar 

  34. Guille JT, Sarwark JF, Sherk HH, Kumar SJ (2006) Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg 14:294–302

    PubMed  Google Scholar 

  35. Gullestad HP, Bretteville G, Lundar T, Enger E (1993) Tissue expansion for the treatment of myelomeningocele. Case report. Scand J Plas Reconstr Surg Hand Surg Nord Plastikkirurgisk Forening Nord Klubb handkirurgi 27:149–151

    Article  CAS  Google Scholar 

  36. Hatlen T, Song K, Shurtlegg D, Duguay S (2010) Contributory factors to postoperative spinal fusion complications for children with myelomeningocele. Spine 35(13):1294–1299

    PubMed  Google Scholar 

  37. Herman JM, McLone DG, Storrs BB, Dauser RC (1993) Analysis of 153 patients with myelomeningocele or spinal lipoma reoperated upon for a tethered cord. Presentation, management and outcome. Pediatr Neurosurg 19:243–249

    Article  CAS  PubMed  Google Scholar 

  38. Hoffer MM, Feiwell E, Perry R, Perry J, Bonnett C (1973) Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am 55:137–148

    CAS  PubMed  Google Scholar 

  39. Holzman RS, Sockin S (1990) Hypotension, flushing, and bronchospasm in myelodysplasia patients (abstract). Anesthesiology 73:1123

    Google Scholar 

  40. Holzman RS (1993) Latex allergy: an emerging operating room problem. Anesth Analg 76:635–641

    CAS  PubMed  Google Scholar 

  41. Kahanovitz N, Duncan JW (1981) The role of scoliosis and pelvic obliquity on functional disability in myelomeningocele. Spine 6:494–497

    Article  CAS  PubMed  Google Scholar 

  42. Karlin L, Zimber S (1990) The association of spondyllisthesis and myelomeningocele. The Pediatric Orthopaedic Society of North America, Annual Meeting, San Francisco

    Google Scholar 

  43. Karol LA, Richards BS, Prejean E, Safavi F (1993) Hemodynamic instability of myelomeningocele patients during anterior spinal surgery. Dev Med Child Neurol 35:261–267

    Article  CAS  PubMed  Google Scholar 

  44. Letts M, Rathbone D, Yamashita T, Nichol B, Keeler A (1992) Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report. J Pediatr Orthop 12:470–474

    Article  CAS  PubMed  Google Scholar 

  45. Lindseth R (2001) Myelomeningocele. In: Morrissy R, Weinstein SL (eds) Lovell and Winter’s pediatric orthopaedics. Lippincott Williams & Wilkins, Philadelphia, pp 601–632

    Google Scholar 

  46. Lindseth RE (1994) Myelomeningocele spine. In: Weinstein SL (ed) The pediatric spine: principles and practice. Raven, New York, pp 1043–1067

    Google Scholar 

  47. Locke MD, Sarwark JF (1996) Orthopedic aspects of myelodysplasia in children. Curr Opin Pediatr 8:65–67

    Article  CAS  PubMed  Google Scholar 

  48. Luciano R, Velardi F (1989) Epidemiology and clues to the etiology of neural tube defects. In: Raimondi A, Choux M, DiRocco C (eds) The pediatric spine I: development and the dysraphic state. Springer, New York, pp 126–147

    Chapter  Google Scholar 

  49. Luque ER (1982) Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 163:192–198

    Google Scholar 

  50. Mayfield JK (1981) Severe spine deformity in myelodysplasia and sacral agenesis: an aggressive surgical approach. Spine 6:498–509

    Article  CAS  PubMed  Google Scholar 

  51. Mazon A, Nieto A, Estornell F, Nieto A, Reig C, Garcia-Ibarra F (1997) Factors that influence the presence of symptoms caused by latex allergy in children with spina bifida. J Allergy Clin Immunol 99:600–604

    Article  CAS  PubMed  Google Scholar 

  52. Mazur J, Menelaus MB, Dickens DR, Doig WG (1986) Efficacy of surgical management for scoliosis in myelomeningocele: correction of deformity and alteration of functional status. J Pediatr Orthop 6:568–575

    Article  CAS  PubMed  Google Scholar 

  53. McLone DG (2003) Tethered cord in spina bifida. In: Lipotak G (ed) Evidence-based practice in spina bifida: developing a research agenda. Spina Bifida Association of America, Washington, DC

    Google Scholar 

  54. McLone DG, Herman JM, Gabrieli AP, Dias L (1990) Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13

    Article  PubMed  Google Scholar 

  55. McMaster MJ (1987) Anterior and posterior instrumentation and fusion of thoracolumbar scoliosis due to myelomeningocele. J Bone Joint Surg 69:20–25

    CAS  Google Scholar 

  56. Meeropol E, Kelleher R, Bell S, Leger R (1990) Allergic reactions to rubber in patients with myelodysplasia. N Engl J Med 323:1072

    CAS  PubMed  Google Scholar 

  57. Miladi LT, Ghanem IB, Draoui MM, Zeller RD, Dubousset JF (1997) Iliosacral screw fixation for pelvic obliquity in neuromuscular scoliosis. A long-term follow-up study. Spine 22:1722–1729

    Article  CAS  PubMed  Google Scholar 

  58. Moneret-Vautrin DA, Laxenaire MC, Bavoux F (1990) Allergic shock to latex and ethylene oxide during surgery for spinal bifida. Anesthesiology 73:556–558

    Article  CAS  PubMed  Google Scholar 

  59. Muller EB, Nordwall A (1992) Prevalence of scoliosis in children with myelomeningocele in western Sweden. Spine 17:1097–1102

    Article  CAS  PubMed  Google Scholar 

  60. Muller EB, Nordwall A (1994) Brace treatment of scoliosis in children with myelomeningocele. Spine 19:151–155

    Article  CAS  PubMed  Google Scholar 

  61. Muller EB, Nordwall A, Oden A (1994) Progression of scoliosis in children with myelomeningocele. Spine 19:147–150

    Article  CAS  PubMed  Google Scholar 

  62. Muller EB, Nordwall A, von Wendt L (1992) Influence of surgical treatment of scoliosis in children with spina bifida on ambulation and motoric skills. Acta Paediatr 81:173–176

    Article  CAS  PubMed  Google Scholar 

  63. Nguyen DH, Burns MW, Shapiro GG, Mayo ME, Murrey M, Mitchell ME (1991) Intraoperative cardiovascular collapse secondary to latex allergy. J Urol 146:571–574

    CAS  PubMed  Google Scholar 

  64. Nieto A, Mazon A, Pamies R, Lanuza A, Munoz A, Estornell F, Garcia-Ibarra F (2002) Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida. J Pediatr 140:370–372

    Article  PubMed  Google Scholar 

  65. Noonan K (2006) Myelominingocele. In: Morrissy R, Weinstein SL (eds) Lovell and Winter’s pediatric orthopaedics. Lippincott Williams & Wilkins, Philadelphia, pp 605–647

    Google Scholar 

  66. Okamoto GA, Lamers JV, Shurtleff DB (1983) Skin breakdown in patients with myelomeningocele. Arch Phys Med Rehabil 64:20–23

    CAS  PubMed  Google Scholar 

  67. Osebold WR, Mayfield JK, Winter RB, Moe JH (1982) Surgical treatment of paralytic scoliosis associated with myelomeningocele. J Bone Joint Surg Am 64:841–856

    CAS  PubMed  Google Scholar 

  68. Paonessa KJ, Zide B, Errico T, Engler GL (1991) Using tissue expanders in spinal surgery for deficient soft tissue or postirradiation cases. Spine 16:S324–S327

    Article  CAS  PubMed  Google Scholar 

  69. Parisini P, Greggi T, Di Silvestre M et al (2002) Surgical treatment of scoliosis in myelomeningocele. In: Griv TB (ed) Research into spinal deformities 4. Ios Press, Amsterdam

    Google Scholar 

  70. Parsch D, Geiger F, Brocai DR, Lang RD, Carstens C (2001) Surgical management of paralytic scoliosis in myelomeningocele. J Pediatr Orthop 10:10–17

    CAS  Google Scholar 

  71. Peelle MW, Lenke LG, Bridwell KH, Sides B (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws. Spine 31:2392–2398; discussion 2399

    Article  PubMed  Google Scholar 

  72. Pierz K, Banta J, Thomson J, Gahm N, Hartford J (2000) The effect of tethered cord release on scoliosis in myelomeningocele. J Pediatr Orthop 20:362–365

    CAS  PubMed  Google Scholar 

  73. Piggott H (1980) The natural history of scoliosis in myelodysplasia. J Bone Joint Surg 62-B:54–58

    CAS  Google Scholar 

  74. Proos LA, Dahl M, Ahlsten G, Tuvemo T, Gustafsson J (1996) Increased perinatal intracranial pressure and prediction of early puberty in girls with myelomeningocele. Arch Dis Child 75:42–45

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  75. Raycroft JF, Curtis BH (1972) Spinal curvature in myelomeningocele: natural history and etiology. Symposium on Myelomeningocele, C.V. Mosby, Hartford

    Google Scholar 

  76. Reigel D (1982) Spina bifida. In: Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons (ed) Pediatric neurosurgery: surgery of the developing nervous system. Grune & Stratton, New York, pp 23–47

    Google Scholar 

  77. Rodgers WB, Frim DM, Emans JB (1997) Surgery of the spine in myelodysplasia. An overview. Clin Orthop Relat Res 338:19–35

    Google Scholar 

  78. Rodgers WB, Williams MS, Schwend RM, Emans JB (1997) Spinal deformity in myelodysplasia. Correction with posterior pedicle screw instrumentation. Spine 22:2435–2443

    Article  CAS  PubMed  Google Scholar 

  79. Samdani AF, Fine AL, Sagoo SS, Shah SC, Cahill PJ, Clements DH, Betz RR (2010) A patient with myelomeningocele: is untethering necessary prior to scoliosis correction? Neurosurg Focus 19(1), E8

    Article  Google Scholar 

  80. Samuelsson L, Eklof O (1988) Scoliosis in myelomeningocele. Acta Orthop Scand 59:122–127

    Article  CAS  PubMed  Google Scholar 

  81. Samuelsson L, Skoog M (1988) Ambulation in patients with myelomeningocele: a multivariate statistical analysis. J Pediatr Orthop 8:569–575

    Article  CAS  PubMed  Google Scholar 

  82. Schoenmakers MA, Gulmans VA, Gooskens RH, Pruijs JE, Helders PJ (2005) Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities. Eur Spine J 14:415–422

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  83. Schut L, Bruce DA, Sutton LN (1983) The management of the child with a lipomyelomeningocele. Clin Neurosurg 30:464–476

    CAS  PubMed  Google Scholar 

  84. Shurtleff DB, Goiney R, Gordon LH, Livermore N (1976) Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report. Dev Med Child Neurol Suppl 37:126–133

    Google Scholar 

  85. Smith JT, Heflin JA, Sponseller P, Karlin L (2013) The use of spinal and rib based distraction systems in early onset scoliosis associated with myelomeningocele. 7th International Congress on early onset scoliosis and growing spine, San Diego, November 21–22

    Google Scholar 

  86. Smucker JD, Miller F (2001) Crankshaft effect after posterior spinal fusion and unit rod instrumentation in children with cerebral palsy. J Pediatr Orthop 21(1):108–112

    Article  CAS  PubMed  Google Scholar 

  87. Sponseller PD, Young AT, Sarwark JF, Lim R (1999) Anterior only fusion for scoliosis in patients with myelomeningocele. Clin Orthop Relat Res 364:117–124

    Google Scholar 

  88. Stanitski CL, Stanitski DF, LaMont RL (1994) Spondylolisthesis in myelomeningocele. J Pediatr Orthop 14:586–591

    Article  CAS  PubMed  Google Scholar 

  89. Stark A, Saraste H (1993) Anterior fusion insufficient for scoliosis in myelomeningocele. 8 children 2–6 years after the Zielke operation. Acta Orthop Scand 64:22–24

    Article  CAS  PubMed  Google Scholar 

  90. Steinbok P, Irvine B, Cochrane DD, Irwin BJ (1992) Long-term outcome and complications of children born with meningomyelocele. Childs Nerv Syst 8:92–96

    Article  CAS  PubMed  Google Scholar 

  91. Stevens DB, Beard C (1989) Segmental spinal instrumentation for neuromuscular spinal deformity. Clin Orthop Relat Res 242:164–168

    PubMed  Google Scholar 

  92. Swank M, Dias L (1992) Myelomeningocele: a review of the orthopaedic aspects of 206 patients treated from birth with no selection criteria. Dev Med Child Neurol 34:1047–1052

    Article  CAS  PubMed  Google Scholar 

  93. Toriello HV, Higgins JV (1983) Occurrence of neural tube defects among first-, second-, and third-degree relatives of probands: results of a United States study. Am J Med Genet 15:601–606

    Article  CAS  PubMed  Google Scholar 

  94. Tosi LL, Slater JE, Shaer C, Mostello LA (1993) Latex allergy in spina bifida patients: prevalence and surgical implications. J Pediatr Orthop 13:709–712

    Article  CAS  PubMed  Google Scholar 

  95. Trivedi J, Thomson JD, Slakey JB, Banta JV, Jones PW (2002) Clinical and radiographic predictors of scoliosis in patients with myelomeningocele. J Bone Joint Surg Am 84-A:1389–1394

    PubMed  Google Scholar 

  96. Wai EK, Young NL, Feldman BM, Badley EM, Wright JG (2005) The relationship between function, self-perception, and spinal deformity: implications for treatment of scoliosis in children with spina bifida. J Pediatr Orthop 25:64–69

    PubMed  Google Scholar 

  97. Ward WT, Wenger DR, Roach JW (1989) Surgical correction of myelomeningocele scoliosis: a critical appraisal of various spinal instrumentation systems. J Pediatr Orthop 9:262–268

    Article  CAS  PubMed  Google Scholar 

  98. Warf BC, Campbell JW (2008) Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long term results of a prospective intent-to-treat study in 115 East African infanta. J Neurosurg Pediatr 2(5):310–316

    Article  PubMed  Google Scholar 

  99. Warf BC, Tracy S, Mugamba J (2012) Long-term outcome for endoscopic third ventriculostmy alone or in combination with chroid plexus cauterization for congenital aquaductal stenosis in African infants. J Neurosurg Pediatr 10(2):108–111

    Article  PubMed  Google Scholar 

  100. Westerlund LE, Gill SS, Jarosz TS, Abel MF, Bianco JS (2001) Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis. Spine 26(18):1984–1989

    Article  CAS  PubMed  Google Scholar 

  101. Wild A, Haak H, Kumar M, Krauspe R (2001) Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele? Spine 26:E325–E329

    Article  CAS  PubMed  Google Scholar 

  102. Winston K, Hall J, Johnson D, Micheli L (1977) Acute elevation of intracranial pressure following transection of non-functional spinal cord. Clin Orthop Relat Res 128:41–44

    Google Scholar 

  103. Wright JG (2011) Hip and spine surgery is of questionable value in spina bifida: an evidence-based review. Clin Orthop Relat Res 469(5):1258–1264

    Article  PubMed Central  PubMed  Google Scholar 

  104. Yazici M, Asher MA, Hardacker JW (2000) The safety and efficacy of Isola–Galveston instrumentation and arthrodesis in the treatment of neuromuscular spinal deformities. J Bone Joint Surg Am 82:524–543

    CAS  PubMed  Google Scholar 

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  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Lawrence I. Karlin MD

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  1. San Diego Center for Spinal Disorders Medical Group, Inc., La Jolla, California, USA

    Behrooz A. Akbarnia

  2. Hacettepe University Dept. Orthopedics & Traumatology, Sihhiye, Ankara, Turkey

    Muharrem Yazici

  3. Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA

    George H. Thompson

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Karlin, L.I. (2016). Myelomeningocele. In: Akbarnia, B., Yazici, M., Thompson, G. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_14

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