Kyphectomy and Pedicular Screw Fixation with Posterior-Only Approach in Pediatric Patients with Myelomeningocele

Abstract

Purpose: Defective posterior spinal arch and paraspinal musculature lead to progressive kyphosis in patients with myelomeningocele. Kyphosis decreases the patients' functional status and quality of life. To correct or prevent further deterioration, different surgical techniques have been introduced. Our aim is to present our clinical experience in kyphectomy and pedicle screw fixation with a posterior-only approach in pediatric patients with myelomeningocele and to discuss the technique with a review of the literature. Materials and Methods: Four patients with lumbar and 2 patients with thoracolumbar kyphosis (female:male ratio = 1:5) secondary to myelomeningocele were operated between January 2009 and October 2012. The median age was 5.5 years (range = 3-10 years). The criteria of the patient selection for the procedure were progression of kyphosis angle, impaired truncal balance and cosmetic deformity. In this retrospective study, we performed chart reviews for demographic and clinical data. We measured the pre- and postoperative kyphosis angles by using the Cobb method on lateral x-rays. Results: The mean preoperative kyphosis angle was 114.3° (range = 91-136°). The mean operative time was 171.7 min (range = 110-220 min). The mean intraoperative blood loss was 450 cc (range = 300-700 cc). The postoperative mean kyphosis angle was 28.2° (range = 13-33°). Five patients had skin breakdown. After osteofusion was established, those 5 patients' instrumentations were explanted. No acute or immediate postoperative complications occurred. Other complications were pneumonia and urinary tract infection. In the long term, 2 patients died due to pneumonia and slit-ventricle syndrome, respectively. Conclusions: Kyphectomy and pedicle screw instrumentation with the posterior-only approach dramatically reduces the kyphosis angle that develops in patients with myelomeningocele. The method itself is less time-consuming and leads to less intraoperative blood loss compared to other methods used for this patient population. Skin breakdown is the most common short-term complication.

Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review

“…Как правило, естественное течение врожденного кифоза на фоне менингомиелоцеле в условиях отсутствия стабильных задних структур позвонков и парадоксального действия сме-щенных вентрально разгибателей позвоночника сопровождается неизбежным прогрессированием деформации со скоростью до 12° в год [3]. Значительный кифоз приводит к нарушению баланса туловища с формированием устойчивого болевого синдрома [13], уменьшению объема грудной и брюшной полостей [14], илиокостальному конфликту [15], невозможности сидеть без опоры на руки [16]. Выраженная угловая деформация осложняет уход за больным, препятствуя использованию инвалидного кресла, а сидение с опорой на крестец провоцирует трофические нарушения [17].…”

History of spine deformity in turkey

“…The first procedures on kyphotic deformities were performed by Dr. Orhan Aslanoğlu ( Figure 8) in 1961, and this study was published in 1963 (14). In 1971 Dr. Ali Akçiçek (Figure 9) presented 53 kyphosis cases on which he performed vertebral Herbert osteotomy ( Figure 10) (58). In this study Kaplan and his colleagues performed neuromonitoring using a somatosensory evoked potential during scoliosis surgery.…”

Modification to the placement of the navigation reference frame in posterior corrective fusion of spinal deformity with myelomeningocele: a series of 6 cases

“…Successful surgery for myelomeningocele deformity correction requires a great deal of knowledge and surgical techniques including attention to perioperative management [1][2][3][4]. Pedicle screws (PS) and iliac screws (IS) have been extensively used in pediatric spinal deformities to improve correction of the deformity and obtain rigid fixation [5][6][7][8].…”