Abstract
Study Design
Retrospective review of prospectively maintained database.
Objectives
To review myelomeningocele patients with severe kyphosis undergoing kyphectomy surgery in terms of complications and clinical and radiographic outcomes.
Summary of Background Data
Because of posterior element abnormality in myelomeningocele, the extensor muscles act as perverted flexors, driving progressive kyphosis that resulted in sitting, respiratory, and skin breakdown problems.
Methods
Clinical case notes and x-rays of seven myelomeningocele patients undergoing kyphectomy surgery were reviewed with a minimum follow-up of 24 months. They consisted of four males and three females with an average age of 9.5 years at surgery. Surgery was performed in three despite open pressure ulcers that failed to heal. These wounds were all closed primarily at initial operation, and no flaps were required. Pedicle screw and sublaminar wire constructs were utilized with iliac screws for distal control.
Results
The median surgical time was 245 minutes (165–285), with an estimated blood loss of 700 mL (500–2,550). The preoperative kyphosis of 142 degrees (90–180) was corrected to 15 degrees (5–45) representing a 92% correction. All experienced improved sitting. There were no early complications but 2 patients with preoperative pressure ulcers returned at 13 months with recurrent sepsis and wound breakdown. Their osteotomy had fused, and the infection settled after instrumentation removal and antibiotic administration.
Conclusion
Although an infrequent presentation today, severe kyphosis in myelomeningocele patients causes not only a major functional impairment but threat to their life with apical pressure sores. Kyphectomy and posterior instrumented spinal fusion can be performed safely, even in the face of an open sore with excellent kyphotic correction and resultant improved functionality and ability to sit. These open sores can be closed primarily without the requirement of plastic surgery as a result of the shortening and extension of the spine.
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RND (grants from Medtronic, grants from Du Puy, personal fees from Medtronic, from null, outside the submitted work); LNB (none).
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Dunn, R.N., Bomela, L.N. Kyphectomy in Children With Severe Myelomeningocele-Related Kyphosis. Spine Deform 4, 230–236 (2016). https://doi.org/10.1016/j.jspd.2015.11.006
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DOI: https://doi.org/10.1016/j.jspd.2015.11.006