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Surgical limits, pitfalls, and potential solutions in kyphectomy in myelomeningocele: three cases and systematic review of the literature

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Abstract

Objectives

To describe surgical treatment of 3 cases of severe and progressive thoracolumbar kyphosis in myelomeningocele and provide a systematic review of the available literature on the topic.

Methods

Medical records and pre- and post-operative imaging of 3 patients with thoracolumbar kyphosis and myelomeningocele were reviewed. A database search was performed for all manuscripts published on kyphectomy and/or surgical treatment of kyphosis in myelomeningocele. Patients’ information, preoperative kyphosis angle, type of surgery, levels of surgery degrees of correction after surgery and at follow-up, and complications were reviewed for the included studies.

Results

Three cases underwent posterior vertebral column resection (pVCR) of 2–4 segments at the apex of the kyphosis (kyphectomy). Long instrumentation was performed with all pedicle screws constructed from the thoracic spine to the pelvis using iliac screws. According to literature review, a total of 586 children were treated for vertebral kyphosis related to myelomeningocele. At least one vertebra was excised to gain some degree of correction of the deformity. Different types of instrumentation were used over time and none of them demonstrated to be superior over the other.

Conclusion

Surgical treatment of progressive kyphosis in myelomeningocele has evolved over the years incorporating all major advances in spinal instrumentation techniques. Certainly, the best results in terms of preservation of correction after surgery and less revision rates were obtained with long construct and screws. However, complication rate remains high with skin problems being the most common complication. The use of low-profile instrumentation remains critical for treatment of these patients.

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Authors and Affiliations

  1. Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124, Turin, Italy

    Raffaele De Marco & Antonio Strangio

  2. Department of Orthopaedics, Azienda Ospedaliera Universitaria “Luigi Vanvitelli”, Università degli Studi della Campania “Luigi Vanvitelli”, 80138, Naples, Italy

    Luigi Aurelio Nasto

  3. Department of Neurosurgery, IRCCS Istituto “G. Gaslini”, 16148, Genoa, Italy

    Gianluca Piatelli & Marco Pavanello

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L.A.N. conceptualized the study; R.D.M. wrote the main manuscript; R.D.M., A.S., and G.P. performed the systematic review; A.S. and R.D.M. prepared tables; R.D.M. prepared Figures 1–4; L.A.N. and M.P. supervised the study group. All authors reviewed the manuscript.

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Correspondence to Raffaele De Marco.

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De Marco, R., Nasto, L.A., Strangio, A. et al. Surgical limits, pitfalls, and potential solutions in kyphectomy in myelomeningocele: three cases and systematic review of the literature. Childs Nerv Syst 40, 1541–1569 (2024). https://doi.org/10.1007/s00381-024-06341-8

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