New Strategies Surgical Complications in Scoliosis Surgery in Children with Mielomeningocele

Abstract

Introduction/Aim Over the years, we have changed strategies regarding scoliosis surgery in myelomeningocele. We compare complication incidence in our previous and current cases. Materials and Methods Medical files of patients with spinal dysgraphia who underwent surgery for neuromuscular scoliosis because of the myelomeningocele were recovered and analyzed. Between 2002 and 2007 (group A), we found 32 patients but 18 with complete records and between 2010 and 2013 (group B) other 10 patients. Group A had 72% women, aged 3 to 25 (average, 11.7 years); and group B had 80% woman, 11 to 15 years of age (average, 13.5 years). We have changed our policies in the last 3 years in neuroprophylaxis, use of urinary catheter, anti-biotherapy, use of hemostatic during surgery, surgical approach, muscle flaps, skin management, use of drains, and others. Results Surgical approaches were anterior, posterior, or both in group A and posterior only in group B. Surgical time averaged 5 hours, in both the groups. Intraoperatory bleeding was 1,445 mL in group A and 1,996 mL in group B. Postoperative intensive care unit stay ranged between 1 to 30 days and 3 to 5 days in groups A and B, respectively, and mechanical ventilation was used between 24 to 72 hours in anterior approaches only. Total hospitalization time averaged 24 days (maximum 62 days) in group A and 10 days (maximum 15 days) in group B. Overall, two incidental durotomies were repaired intraoperatively in group A. Postoperatively, the most common complication was infection, one superficial and four deep ones. One patient presented hypokalemia and edematous syndrome in group A. In group B, one screw was malpositioned and required replacement, one patient had a wound dehiscence, and one deep infection that required implant removal. One patient had a severe screw pullout after a wall fell over her during the 2010 earthquake. In the long term, two patients presented screw loosening, one hardware failure, one screw pullout, and one nonunion in group A. In group B, one patient's screw inners became loose and needed replacement. Discussion We studied correlation between long- and short-term complications, surgical time and blood loss, and found less complications and shorter hospital stays in group B. We discuss the different techniques and strategies currently in use for these patients. Conclusion Scoliosis surgery in patients with spinal dysgraphia has a high incidence of complications, in our series (25%). New strategies have developed in recent years to decrease them.