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Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review

  • Symposium: Myelomeningocele
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Kyphosis in myelomeningocele is a rare and difficult problem. Many strategies have been used with no single procedure universally agreed on. Techniques involving anterior and posterior fixation may provide better fusion.

Questions/purposes

We describe a novel procedure for anteroposterior kyphectomy in patients with myelomeningocele. Apical posterior kyphectomy is followed by the insertion of two rods distally into the vertebral bodies and sacrum. Sublaminar wires are placed superiorly and the kyphosis is reduced by sequential tightening. We determined kyphosis correction and intraoperative blood loss for this new procedure

Methods

We retrospectively reviewed 22 patients (average age, 7.6 years [range, 2–17 years]) who underwent apical kyphectomy from 1982 to 2008. Charts were examined and radiographs measured preoperatively, immediately postoperatively, and at final followup. Followup averaged 6.4 years (range, 0–14 years) with 19 patients having at least 2 years of followup.

Results

Kyphosis decreased from a mean of 123° (range, 79°–163°) preoperatively to 40° (range, 13°–92°) immediately postoperatively and was a mean of 60° (range, 14°–126°) at final followup. Operating time was 248 minutes (range, 180–345 minutes), estimated blood loss was 765 mL (range, 140–2100 mL), and length of stay was 14 days (range, 1–57 days). Ten of the 22 patients had complications with eight requiring reoperation.

Conclusions

This anteroposterior kyphectomy provided a high level of kyphosis correction, which was largely maintained over the study period. Blood loss, surgical time, and complication rates were acceptable as compared with other techniques reported in the literature.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Ms Maureen Marriott for her tireless efforts without which this study could not have been presented.

Author information

Authors and Affiliations

  1. 100 Arden Street, Suite 414, Moncton, NB, E1C 4B7, Canada

    Sean A. Comstock MD

  2. Department of Orthopaedics, Dartmouth College, Hanover, NH, USA

    P. Chris Cook MD

  3. Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada

    J. Lorne Leahey MD, Ron El-Hawary MD & John C. Hyndman MD

Authors
  1. Sean A. Comstock MD
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  2. P. Chris Cook MD
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  3. J. Lorne Leahey MD
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  4. Ron El-Hawary MD
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  5. John C. Hyndman MD
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Corresponding author

Correspondence to Sean A. Comstock MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Isaac Walton Killam Children’s Hospital, Dalhousie University, Halifax, Nova Scotia, Canada.

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Comstock, S.A., Cook, P.C., Leahey, J.L. et al. Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review. Clin Orthop Relat Res 469, 1265–1271 (2011). https://doi.org/10.1007/s11999-010-1611-2

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  • DOI: https://doi.org/10.1007/s11999-010-1611-2

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