Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele

Fürderer, S.; Hopf, C.; Schwarz, Manfred; Voth, D.

doi:10.1007/s101430050008

Cited by 20 publications

(24 citation statements)

References 8 publications

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“…Although techniques for treatment of this condition have evolved, a definitive ''gold standard'' procedure, with uniformly predictable outcomes, remains elusive. The incidence of MMC is between 0.005% and 0.2% of all live births [6,7]. Deformities in MMC occur in 50% of patients [7].…”

Section: Introductionmentioning

confidence: 99%

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Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review

Comstock¹,

Cook

Leahey

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Kyphosis in myelomeningocele is a rare and difficult problem. Many strategies have been used with no single procedure universally agreed on. Techniques involving anterior and posterior fixation may provide better fusion. Questions/purposes We describe a novel procedure for anteroposterior kyphectomy in patients with myelomeningocele. Apical posterior kyphectomy is followed by the insertion of two rods distally into the vertebral bodies and sacrum. Sublaminar wires are placed superiorly and the kyphosis is reduced by sequential tightening. We determined kyphosis correction and intraoperative blood loss for this new procedure Methods We retrospectively reviewed 22 patients (average age, 7.6 years [range, 2-17 years]) who underwent apical kyphectomy from 1982 to 2008. Charts were examined and radiographs measured preoperatively, immediately postoperatively, and at final followup. Followup averaged 6.4 years (range, 0-14 years) with 19 patients having at least 2 years of followup. Results Kyphosis decreased from a mean of 123°(range, 79°-163°) preoperatively to 40°(range, 13°-92°) immediately postoperatively and was a mean of 60°(range, 14°-126°) at final followup. Operating time was 248 minutes (range, 180-345 minutes), estimated blood loss was 765 mL (range, 140-2100 mL), and length of stay was 14 days (range, 1-57 days

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Section: Introductionmentioning

confidence: 99%

“…The incidence of MMC is between 0.005% and 0.2% of all live births [6,7]. Deformities in MMC occur in 50% of patients [7]. Congenital kyphosis and kyphoscoliosis are less common than congenital scoliosis [24,25], occurring in 8% to 28% of these patients [4,6,12,18,22,26,28,34].…”

Section: Introductionmentioning

confidence: 99%

Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review

Comstock¹,

Cook

Leahey

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…11,12,19,21 One of the patients operated in this series evolved with loosening of the rod in the sacrum and required removal of the synthesis material after one year of follow-up. Although pedicle screws offer better pull-out resistance and better results in idiopathic scoliosis, 15,16,22 it is still not known whether their use in cases of kyphectomy will reduce the rate of failure of the material.…”

Section: Discussionmentioning

confidence: 99%

Kyphectomy in Patients With Myelomeningocele: Surgical Results and Complications

et al. 2015

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Objectives: The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients. Method: Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine. Results: Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum. Conclusion: The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

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“…The surgical treatment of such patients often involves significant complication rates [8,12]. One patient in this subgroup died one month postoperatively after a sudden unexplained increase in intracranial pressure on day 2 post surgery, resulting in a hypoxic brain incident (the spinal surgery itself was considered successful).…”

Section: Discussionmentioning

confidence: 99%

The use of physical biomodelling in complex spinal surgery

Izatt

Thorpe

Thompson³

et al. 2007

Eur Spine J

103

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Prior studies have suggested that biomodels enhance patient education, preoperative planning and intra-operative stereotaxy; however, the usefulness of biomodels compared to regular imaging modalities such as X-ray, CT and MR has not been quantified. Our objective was to quantify the surgeon's perceptions on the usefulness of biomodels compared to standard visualisation modalities for preoperative planning and intra-operative anatomical reference. Physical biomodels were manufactured for a series of 26 consecutive patients with complex spinal pathologies using a stereolithographic technique based on CT data. The biomodels were used preoperatively for surgical planning and customising implants, and intraoperatively for anatomical reference. Following surgery, a detailed biomodel utility survey was completed by the surgeons, and informal telephone interviews were conducted with patients. Using biomodels, 21 deformity and 5 tumour cases were performed. Surgeons stated that the anatomical details were better visible on the biomodel than on other imaging modalities in 65% of cases, and exclusively visible on the biomodel in 11% of cases. Preoperative use of the biomodel led to a different decision regarding the choice of osteosynthetic materials used in 52% of cases, and the implantation site of osteosynthetic material in 74% of cases. Surgeons reported that the use of biomodels reduced operating time by a mean of 8% in tumour patients and 22% in deformity procedures. This study supports biomodelling as a useful, and sometimes essential tool in the armamentarium of imaging techniques used for complex spinal surgery.

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Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele

Cited by 20 publications

References 8 publications

Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review

Posterior Kyphectomy for Myelomeningocele With Anterior Placement of Fixation: A Retrospective Review

Kyphectomy in Patients With Myelomeningocele: Surgical Results and Complications

The use of physical biomodelling in complex spinal surgery

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