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Surgical Management of Kyphosis in Meningomyelocele

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The Growing Spine

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Abstract

Spinal deformities, particularly scoliosis and kyphosis, are frequently encountered in patients with myelomeningocele. Rigid lumbar and thoracolumbar kyphosis presents serious functional impediments with regard to sitting balance, and the use of upper extremities other than for balance can lead to chronic skin breakdown over the gibbus deformity. Many patients are unable to lie supine because of the severe deformity, and bracing has not been shown to change the natural history of the kyphosis. Surgery is the only proven method to improve the sagittal spine alignment leading to improvements in posture, sitting balance, as well as ability of the caretaker to provide care for the patient. Several types of kyphectomies have been shown to have excellent results with regard to the sagittal plane correction. Vertebral column resections with multiple different options for instrumentation have been studied extensively. Decancellation vertebrectomies, also known as pedicle subtraction osteotomies or eggshell procedures, have also been demonstrated to achieve adequate kyphosis correction and are a viable option as well. Although these procedures are effective in achieving preoperative goals, it must be noted that there is a high incidence of perioperative complications that the surgeon and family must also be aware of. This chapter will discuss the background of the deformity, the perioperative issues revolving around the treatment, the surgical details including different strategies, a result reviews from the past, as well as the most common complications seen during kyphectomy in myelomeningocele patients.

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References

  1. Sarwark JF (1996) Spina bifida. Pediatr Clin North Am 43(5):1151–1158

    Article  CAS  PubMed  Google Scholar 

  2. Guille JT et al (2006) Congenital and developmental deformities of the spine in children with myelomeningocele. J Am Acad Orthop Surg 14(5):294–302

    PubMed  Google Scholar 

  3. Sarwark JF (1999) Kyphosis deformity in myelomeningocele. Orthop Clin North Am 30(3):451–455, viii–ix

    Article  CAS  PubMed  Google Scholar 

  4. Lintner SA, Lindseth RE (1994) Kyphotic deformity in patients who have a myelomeningocele. Operative treatment and long-term follow-up. J Bone Joint Surg Am 76(9):1301–1307

    CAS  PubMed  Google Scholar 

  5. Lindseth RE, Stelzer L Jr (1979) Vertebral excision for kyphosis in children with myelomeningocele. J Bone Joint Surg Am 61(5):699–704

    CAS  PubMed  Google Scholar 

  6. Carstens C et al (1996) Development of pathological lumbar kyphosis in myelomeningocele. J Bone Joint Surg Br 78(6):945–950

    Article  CAS  PubMed  Google Scholar 

  7. Furderer S et al (1999) Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele. Neurosurg Rev 22(1):45–49

    Article  CAS  PubMed  Google Scholar 

  8. Comstock SA et al (2011) Posterior kyphectomy for myelomeningocele with anterior placement of fixation: a retrospective review. Clin Orthop Relat Res 469(5):1265–1271

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mintz LJ et al (1991) The natural history of congenital kyphosis in myelomeningocele. A review of 51 children. Spine (Phila Pa 1976) 16(8 Suppl):S348–S350

    CAS  Google Scholar 

  10. Martin J Jr et al (1994) Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment. J Pediatr Orthop 14(3):323–328

    Article  PubMed  Google Scholar 

  11. Sarwark JF et al (1996) Tethered cord syndrome in low motor level children with myelomeningocele. Pediatr Neurosurg 25(6):295–301

    Article  CAS  PubMed  Google Scholar 

  12. Altiok H et al (2011) Kyphectomy in children with myelomeningocele. Clin Orthop Relat Res 469(5):1272–1278

    Article  PubMed Central  PubMed  Google Scholar 

  13. Garg S et al (2011) Kyphectomy improves sitting and skin problems in patients with myelomeningocele. Clin Orthop Relat Res 469(5):1279–1285

    Article  PubMed Central  PubMed  Google Scholar 

  14. Niall DM et al (2004) Kyphectomy in children with myelomeningocele: a long-term outcome study. J Pediatr Orthop 24(1):37–44

    Article  CAS  PubMed  Google Scholar 

  15. Eckstein HB, Vora RM (1972) Spinal osteotomy for severe kyphosis in children with myelomeningocele. J Bone Joint Surg Br 54(2):328–333

    CAS  PubMed  Google Scholar 

  16. Nolden MT et al (2002) A kyphectomy technique with reduced perioperative morbidity for myelomeningocele kyphosis. Spine (Phila Pa 1976) 27(16):1807–1813

    Article  Google Scholar 

  17. Huang TJ, Lubicky JP (1994) Kyphectomy and segmental spinal instrumentation in young children with myelomeningocele kyphosis. J Formos Med Assoc 93(6):503–508

    CAS  PubMed  Google Scholar 

  18. Winston K et al (1977) Acute elevation of intracranial pressure following transection of non-functional spinal cord. Clin Orthop Relat Res 128:41–44

    PubMed  Google Scholar 

  19. Akbar M et al (2006) Kyphectomy in children with myelodysplasia: results 1994–2004. Spine (Phila Pa 1976) 31(9):1007–1013

    Article  Google Scholar 

  20. Heydemann JS, Gillespie R (1987) Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation. Spine (Phila Pa 1976) 12(1):37–41

    Article  CAS  Google Scholar 

  21. Ko AL et al (2007) Retrospective review of multilevel spinal fusion combined with spinal cord transection for treatment of kyphoscoliosis in pediatric myelomeningocele patients. Spine (Phila Pa 1976) 32(22):2493–2501

    Article  Google Scholar 

  22. McCall RE (1998) Modified luque instrumentation after myelomeningocele kyphectomy. Spine (Phila Pa 1976) 23(12):1406–1411

    Article  CAS  Google Scholar 

  23. McMaster MJ (1988) The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele. Spine (Phila Pa 1976) 13(4):417–424

    Article  CAS  Google Scholar 

  24. Odent T et al (2004) Kyphectomy in myelomeningocele with a modified Dunn-McCarthy technique followed by an anterior inlayed strut graft. Eur Spine J 13(3):206–212

    Article  PubMed Central  PubMed  Google Scholar 

  25. Warner WC Jr, Fackler CD (1993) Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodysplasia. J Pediatr Orthop 13(6):704–708

    Article  PubMed  Google Scholar 

  26. Kadic MA, Verbout AJ (1991) Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods. Acta Orthop Belg 57(1):45–51

    CAS  PubMed  Google Scholar 

  27. Sharrard WJ (1968) Spinal osteotomy for congenital kyphosis in myelomeningocele. J Bone Joint Surg Br 50(3):466–471

    CAS  PubMed  Google Scholar 

  28. McCarthy RE, Dunn H, McCullough FL (1989) Luque fixation to the sacral ala using the Dunn-McCarthy modification. Spine (Phila Pa 1976) 14(3):281–283

    Article  CAS  Google Scholar 

  29. Schroeder JE et al (2011) Long-term outcome of surgical correction of congenital kyphosis in patients with myelomeningocele (MMC) with segmental spino-pelvic fixation. Evid Based Spine Care J 2(1):17–22

    Article  PubMed Central  PubMed  Google Scholar 

  30. Samagh SP et al (2011) Kyphectomy in the treatment of patients with myelomeningocele. Spine J 11(3):e5–e11

    Article  PubMed  Google Scholar 

  31. de Amoreira Gepp R et al (2013) Kyphectomy in meningomyelocele children: surgical technique, risk analysis, and improvement of kyphosis. Childs Nerv Syst

    Google Scholar 

  32. Hwang SW et al (2011) Kyphectomy in patients with myelomeningocele treated with pedicle screw-only constructs: case reports and review. J Neurosurg Pediatr 8(1):63–70

    Article  PubMed  Google Scholar 

  33. Kim KT et al (2012) Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976) 37(19):1667–1675

    Article  Google Scholar 

  34. Spiro AS et al (2013) Surgical treatment of severe congenital thoracolumbar kyphosis through a single posterior approach. Bone Joint J 95-B(11):1527–1532

    Article  CAS  PubMed  Google Scholar 

  35. Bakaloudis G et al (2011) Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J 20(Suppl 1):S95–S104

    Article  PubMed  Google Scholar 

  36. Kim YJ et al (2007) Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 32(20):2189–2197

    Article  Google Scholar 

  37. Hyun SJ, Kim YJ, Rhim SC (2013) Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients. World J Clin Cases 1(8):242–248

    Article  PubMed Central  PubMed  Google Scholar 

  38. Silverstein MP, St Clair SF, Lieberman IH (2012) Thoracic pedicle subtraction osteotomy in a pediatric patient: a case report. Evid Based Spine Care J 3(2):49–54

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA

    Jozef Murar MD

  2. Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    John F. Sarwark MD

Authors
  1. Jozef Murar MD
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  2. John F. Sarwark MD
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Correspondence to John F. Sarwark MD .

Editor information

Editors and Affiliations

  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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Murar, J., Sarwark, J.F. (2016). Surgical Management of Kyphosis in Meningomyelocele. In: Akbarnia, B., Yazici, M., Thompson, G. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_34

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  • DOI: https://doi.org/10.1007/978-3-662-48284-1_34

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48283-4

  • Online ISBN: 978-3-662-48284-1

  • eBook Packages: MedicineMedicine (R0)

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