Kyphectomy in Children with Myelomeningocele

Altıok, Haluk; Finlayson, Craig J; Hassani, Sahar; Sturm, Peter

doi:10.1007/s11999-010-1641-9

Cited by 34 publications

(15 citation statements)

References 23 publications

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“…Some authors mentioned the importance of maximum correction in the index surgery for better long-term results [21,33]. The follow-up period in the literature ranged from 12 to 133 months, while the mean follow-up period in our series was 30 months [1,3,4,6,7,8,9,11,13,14,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47] (table 2). …”

Section: Discussionmentioning

confidence: 86%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 86%

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

et al. 2015

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“…Conservative treatment may include bracing and wheelchair modification, but it is ineffective in severe deformities. Corrective surgery has a high morbidity rate including wound infection, wound healing disorder, pseudarthrosis, and cerebrospinal fluid leakage [3, 4, 6, 8, 9]. According to previous studies, the optimal age for surgical treatment is 8 years and above, however, operations may be performed between the ages of 5 and 12 years [4, 8].…”

Section: Discussionmentioning

confidence: 99%

Multisegmental Lumbar Corporectomy and Transcorporal Fixation for Correction of Extreme Thoracolumbar Kyphosis in Myelomeningocele with Chronic Decubitus

et al. 2018

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We introduce a novel technique for the treatment of severe kyphosis in myelomeningocele. A 5-year-old paraplegic boy with myelomeningocele presented with severe thoracolumbar kyphosis and a chronic ulcus at the site of the gibbus. The myelomeningocele had been treated during his first week of life, and an accompanying Chiari type II malformation had been treated by ventriculoperitoneal shunting. He subsequently developed a rapidly progressive thoracolumbar kyphosis with an angle of 180° between T10 and L5. He also suffered from a chronic superinfected skin ulcus at the site of the gibbus. Since the skin ulcus required plastic surgery reconstruction, we deemed classical posterior fixation after kyphectomy unfeasible. The subsequent operative steps of our novel surgical approach were performed in a single-stage surgery. First, a three-level lumbar corporectomy from L1 to L3 was performed. Subsequently, the body of the removed L2 vertebra was isolated and configured as an autologous graft to bridge the gap between the thoracic and the caudal lumbar spine. The graft was fixed via a transcorporal interbody fusion technique with titanium screws, and chopped autologous bone was added for fusion. The skin was closed using rotation flaps. At the 3-year follow-up, the patient and his family reported marked improvement of quality of life, imaging showed solid fusion and the wound was unremarkable. Our novel technique with transcorporal fixation provides new perspectives in the treatment of severe kyphosis and skin ulceration in myelomeningocele.

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“…A significant number of patients with open neural tube defects require surgical stabilization or deformity correction [3,4,5,6,7,13,16,17]. With the increased popularity of spinal shortening osteotomies in the management of multiply retethered patients, the proper anatomic trajectory and quantitative measures can be invaluable to surgeons [17].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with myelomeningoceles often require corrective surgery for resulting spinal deformities [3,4,5,6,7,8]. While the etiology is not entirely understood, it is hypothesized that a lack of spinal posterior elements contributes to decreased posterior tension [3,6].…”

Section: Introductionmentioning

confidence: 99%

“…While the etiology is not entirely understood, it is hypothesized that a lack of spinal posterior elements contributes to decreased posterior tension [3,6]. This decreased stability often causes positive sagittal balance, resulting in a progressive kyphosis in 8-28% of patients, progressing at an average rate of 3° per year, or in scoliosis in 5-100% of patients, progressing at 8° per year [4,5,7,8,9,10,11]. Typically, spinal deformity arising from dysraphism continues to progress even after growth cessation, thus carrying an even more urgent need for surgical correction [5,7].…”

Section: Introductionmentioning

confidence: 99%

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Morphometric Analysis of Lumbar Pedicles in Patients with Spinal Dysraphism

Engelberg¹,

Roguski²,

Riesenburger³

et al. 2015

Pediatr Neurosurg

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Background: In patients with open neural tube defects, the incidence of scoliosis and requirement for spinal fusions are increased. Historically, there has been no standardized measurement of vertebral morphometry in these patients. However, anecdotally, patients with open neural tube defects have a more medially oriented lumbar pedicle trajectory than the average population. Methods: A single-institution retrospective review of patients with open neural tube defects was conducted. The demographic parameters and functional and anatomical levels of the defects were noted. CT and MRI scans of the lumbar spine were analyzed; the pedicles from L₁ to S₁ were measured for width (W), length (L) and midline angle (α). The measurements were compared bilaterally, at each level, and with data from previously published reports. Results: 16 scans of pediatric patients (mean = 3.0 ± 4.3; age range = 7 days to 14.4 years; 7 males, 9 females) with a diagnosis of either myelomeningocele or lipomyelomeningocele were assessed. Most defects occurred in the lumbar region, with L₂ and L₅ accounting for 37.5% each. All angles demonstrated a quadratic increase from L₁ to S₁ (means: L₁ = 28.3 ± 5.24°; L₂ = 29.1 ± 6.2°; L₃ = 33.2 ± 6.0°; L₄ = 36.8 ± 5.6°; L₅ = 43.8 ± 5.9°; S₁ = 52.0 ± 3.6°) and were more medially angulated than those reported previously; no significant difference existed between right and left measurements (W = 0.65 ≤ p ≤ 0.94; L = 0.91 ≤ p ≤ 1; α = 0.24 ≤ p ≤ 0.86). Conclusions: Patients with open neural tube defects had more medially angled pedicle trajectories in the lumbar spine when compared to previously reported values.

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Kyphectomy in Children with Myelomeningocele

Cited by 34 publications

References 23 publications

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

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

Multisegmental Lumbar Corporectomy and Transcorporal Fixation for Correction of Extreme Thoracolumbar Kyphosis in Myelomeningocele with Chronic Decubitus

Morphometric Analysis of Lumbar Pedicles in Patients with Spinal Dysraphism

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