Skip to main content

Advertisement

SpringerLink
Log in

Short-term surgical complications of spinal fusion in myelomeningocele

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Retrospective review of a prospective database.

Purpose

To determine the rate of short-term surgical complications in the 3-month postoperative period in patients with myelomeningocele (MMC) who underwent surgical correction of spine deformities.

Methods

This study reviewed the medical records of MMC patients, aged ≤ 18 years, who underwent spine deformity correction between 2012 and 2018. Clinical, radiological, and surgical variables were considered.

Results

Forty-six patients with primary preoperative curve, pelvic obliquity, and kyphosis mean values of 84.9º, 21.5º, and 76.1º, respectively, were included. Thirty-four (74%) patients underwent scoliosis correction and 12 (26%), kyphectomy. A trend in reduction of %EBV (estimated blood volume) loss with antifibrinolytic use from 50.2 ± 32.3 to 33.8 ± 17.2% was observed (p = 0.103). Simultaneous detethering was performed in 13 (27.7%) patients and was not associated with higher short-term complication rates. There were 12 cases of short-term surgical complications (26.1%); among them, six had deep wound infection requiring surgical debridement, and one a superficial wound infection. Drainage time longer than 4 days was significantly associated with wound infection (OR = 15.8, p = 0.01).

Conclusions

The surgical treatment of neuromuscular scoliosis in MMC patients is challenging because of the high comorbidity rate. Still, we found an admissible rate of short-term surgical complications with a multidisciplinary approach in a setting with extensive spine deformity surgery experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mohamad F, Parent S, Pawelek J, Marks M, Bastrom T, Faro F, Newton P (2007) Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop 27:392–397

    Article  Google Scholar 

  2. Mummareddy N, Dewan MC, Mercier MR, Naftel RP, Wellons JC 3rd, Bonfield CM (2017) Scoliosis in myelomeningocele: epidemiology, management, and functional outcome. J Neurosurg Pediatr 20:1–10

    Article  Google Scholar 

  3. Canaz H, Alatas I, Canaz G, Gumussuyu G, Cacan MA, Saracoglu A, Ucar BY (2018) Surgical treatment of patients with myelomeningocele-related spine deformities: study of 26 cases. Childs Nerv Syst 34:1367–1374

    Article  Google Scholar 

  4. Winter RB, Pinto WC (1986) Pelvic obliquity, Its causes and its treatment. Spine 11:225–234

    Article  CAS  Google Scholar 

  5. Caldarelli M, Boscarelli A, Massimi L (2013) Recurrent tethered cord: radiological investigation and management. Childs Nerv Syst 29:1601–1609

    Article  Google Scholar 

  6. 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 Jt Surg Am 71:548–562

    Article  CAS  Google Scholar 

  7. Broom MJ, Banta JV, Renshaw TS (1989) Spinal fusion augmented by Luque-rod segmental instrumentation for neuromuscular scoliosis. J Bone Jt Surg Am 71:32–44

    Article  CAS  Google Scholar 

  8. Jain A, Sullivan BT, Kuwabara A, Kebaish KM, Sponseller PD (2017) Sacral-alar-iliac fixation in children with neuromuscular scoliosis: minimum 5-year follow-up. World Neurosurg 108:474–478

    Article  Google Scholar 

  9. Ollesch B, Brazell C, Carry PM, Georgopoulos G (2018) Complications, results, and risk factors of spinal fusion in patients with myelomeningocele. Spine Deform 6:460–466

    Article  Google Scholar 

  10. Ward JP, Feldman DS, Paul J, Sala DA, Errico TJ, Otsuka NY, Margiotta MS (2017) Wound closure in nonidiopathic scoliosis: does closure matter? J Pediatr Orthop 37(3):166–170

    Article  Google Scholar 

  11. Rumalla K, Yarbrough CK, Pugely AJ, Koester L, Dorward IG (2016) Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine 25:500–508

    Article  Google Scholar 

  12. Martin CT, Pugely AJ, Gao Y, Ilgenfritz RM, Weinstein SL (2014) Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP. Spine (Phila Pa1976) 39:1463–1470

    Article  Google Scholar 

  13. Master DL, Son-Hing JP, Poe-Kochert C, Armstrong DG, Thompson GH (2011) Risk factors for major complications after surgery for neuromuscular scoliosis. Spine Phila Pa (1976) 36:564–571

    Article  Google Scholar 

  14. Turturro F, Montanaro A, Calderaro C, Labianca L, Di Sanzo V, Ferretti A (2017) Rate of complications due to neuromuscular scoliosis spine surgery in a 30-years consecutive series. Eur Spine J 26:539–545

    Article  Google Scholar 

  15. McLeod L, Flynn J, Erickson M, Miller N, Keren R, Dormans J (2016) Variation in 60-day readmission for surgical-site infections (SSIs) and reoperation following spinal fusion operations for neuromuscular scoliosis. J Pediatr Ortho 36:634–639

    Article  Google Scholar 

  16. Berry JG, Glotzbecker M, Rodean J, Leahy I, Hall M, Ferrari L (2017) Comorbidities and complications of spinal fusion for scoliosis. Pediatrics 139. pii:e20162574

    Article  Google Scholar 

  17. Petersen PA, Marcon RM, Letaif OB et al (2020) Does kyphectomy improve the quality of life of patients with myelomeningocele? Clin Orthop Relat Res 478(1):104–111

    Article  Google Scholar 

  18. Ramo BA, Roberts DW, Tuason D et al (2014) Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: a thirty-year experience at a single institution. J Bone Jt Surg Am 96(24):2038–2048

    Article  Google Scholar 

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

    Article  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge Mrs. Erika Carvalho Pires Arci for her valuable statistical assistance.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Pediatrics and Rehabilitation, SARAH Network of Rehabilitation Hospitals, SMHS Qd 301 Bloco A, Brasília, DF, 70335-901, Brazil

    Alex Oliveira de Araújo, Cícero Ricardo Gomes, Daniela Fava, Eliana Valverde Magro Borigato, Lenamaris Mendes Rocha Duarte & Rafael Garcia de Oliveira

Authors
  1. Alex Oliveira de Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cícero Ricardo Gomes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Fava
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eliana Valverde Magro Borigato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lenamaris Mendes Rocha Duarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rafael Garcia de Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AOdA, DF, LMRD, RGdO: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. AOdA, CRG, DF, EVMB, LMRD, RGdO: Drafted the work or revised it critically for important intellectual content. AOdA, CRG, DF, EVMB, LMRD, RGdO: Approved the version to be published. AOdA, CRG, DF, EVMB, LMRD, RGdO: Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Rafael Garcia de Oliveira.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Research Ethics Committee approval: 08053919.0.0000.0022.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Araújo, A.O., Gomes, C.R., Fava, D. et al. Short-term surgical complications of spinal fusion in myelomeningocele. Spine Deform 9, 1151–1159 (2021). https://doi.org/10.1007/s43390-021-00304-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-021-00304-8

Keywords

Search

Navigation