Congenital and Developmental Deformities of the Spine in Children With Myelomeningocele

Guille, James T.; Sarwark, John F.; Sherk, Henry H.; Kumar, S. Jay

doi:10.5435/00124635-200605000-00005

Cited by 63 publications

(52 citation statements)

References 42 publications

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“…The purpose of treatment was to optimize spine alignment and maximize thoracic volume while maintaining thoracic and spine growth [2,5]. Without treatment, increase in spinal deformity with loss of spine alignment and increased functional impairment and deterioration of respiratory function would be expected [10]. We therefore asked whether the use of the VEPTR in immature nonambulating children with myelodysplasia with spinal deformity would (1) correct deformity; (2) allow growth; and (3) allow adequate respiratory function.…”

Section: Discussionmentioning

confidence: 99%

“…Establishing absolute criteria for surgical correction of spinal deformity in patients with spina bifida is unclear because the long-term natural history of untreated deformity is limited [10]. Muller et al established that progression in patients with spina bifida was related to the size of the curve: curves less than 20°progressed slowly and curves greater than 40°progressed at a rate of 13°per year [13].…”

Section: Discussionmentioning

confidence: 99%

“…Mortality and complication rates appear acceptable in this high-risk population of patients with spina bifida [1,10,12,15]. In previous series, wound infection has been reported to occur in up to half of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Little is known about the natural history of the untreated spinal deformity [10]. Marchesi et al separated the deformity into congenital and developmental curves [11].…”

Section: Introductionmentioning

confidence: 99%

“…Carstens et al evaluated 13 patients with spina bifida and detected restrictive changes in pulmonary function preoperatively [6]. Treatment for immature children with myelodysplasia and spinal deformity is complex with scanty information in the literature to guide treatment [10].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Flynn

Ramírez

Emans

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Nonambulatory children with myelodysplasia are most likely to develop spinal deformity. As the deformity progresses, the overall health of the patient deteriorates. Traditional management of the deformity with fusion results in a short trunk, crankshaft deformity, and spine and lung growth inhibition. One alternative that potentially minimizes these problems is the vertebral expandable prosthetic titanium rib (VEPTR). Questions/purposes We therefore asked whether the use of the VEPTR in immature nonambulating children with myelodysplasia with spinal deformity would (1) correct deformity; (2) allow growth; and (3) allow adequate respiratory function. Patients and Methods We identified 20 nonambulatory patients with myelodysplasia who were part of a multicenter Investigational Device Exemption study of 214 patients treated with the VEPTR system. Demographics, standard radiographic measurements, pulmonary function parameters, and complications in 16 patients were analyzed. Average age at first surgery was 48.6 months. The minimum followup was 25 months (mean, 59 months; range, 25-164 months). Results The Cobb angle decreased postoperatively in nine patients, increased less than 10°in five patients, and increased less than 20°in two patients. The mean increase in thoracic spinal length (growth) by year after the initial procedure with lengthening was 0.48 cm. Ventilatory function improved in 11 patients and deteriorated in five patients. Intraoperative complications occurred in two patients. Complications directly related to the implant were seven infections and five implant migrations. Conclusions Our observations suggest VEPTR is a reasonable treatment option for spinal deformity in the immature, nonambulatory myelodysplasia population correcting the spinal deformity, allowing spinal growth, and maintaining adequate respiratory function. The rate of complications is within the range reported for spinal fusion using standard approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Little is known about the natural history of the untreated spinal deformity [10]. Marchesi et al separated the deformity into congenital and developmental curves [11].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Flynn

Ramírez

Emans

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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Orthopedic management of spina bifida

Thomson

Segal

2010

Dev Disabil Res Revs

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The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of knee pain. The importance of the hip abductor muscle and its influence on gait and knee function has been realized. Important developments in the treatment of spinal deformity include the use of pedicle screws which allow better correction. The role of anterior-only spinal surgery has been defined, which allows motion at the lumbo-sacral junction and has a lower postoperative infection rate than posterior surgery. Functional outcome assessments provide better feedback for surgeons and families in regards to which patients may benefit most from surgery. Overall, the past 10 years has seen the increased use of functional outcome measures such as Motion Analysis, oxygen consumption, and patient-based outcome assessments rather than traditional radiographic measures (e.g., hip dislocation or subluxation). This progress has resulted in a better understanding of spina bifida and, more importantly, improved outcomes for our patients. Additional research is likely to further enhance outcomes by establishing additional evidence-based interventions.

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Neural Tube Defects, Spina Bifida, and Spinal Dysraphism

Graham¹,

Parsch²

2011

Children's Neuromuscular Disorders

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Congenital and Developmental Deformities of the Spine in Children With Myelomeningocele

Cited by 63 publications

References 42 publications

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Is the Vertebral Expandable Prosthetic Titanium Rib a Surgical Alternative in Patients with Spina Bifida?

Orthopedic management of spina bifida

Neural Tube Defects, Spina Bifida, and Spinal Dysraphism

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