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

Abstract

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

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

“…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). …”

Kyphectomy in Myelomeningocele for Severe Early-Onset Kyphosis Using Distal Intravertebral Fixation and Thoracic Growing Rods

“…Despite this theoretical concern, we feel that the stable anterior multilevel intravertebral fixation achieved with the Halifax kyphectomy technique allows for a cantilever to reduce both sagittal and coronal plane deformity in the lumbosacral spine, particularly when the distal extent of fixation extends to S1 or below, as is technically feasible. 15,24…”

“…Most kyphectomy techniques require distal dissection of the bifid posterior spinal elements for the placement of implants in the thoracolumbar/pelvic regions, traversing the scarred tissue associated with the previous MMC closure, and theoretically increasing the risk of postoperative infection. To avoid this compromised area, similar techniques have been reported by centers in Canada (the so-called Halifax kyphectomy ) 15 and Australia, 4 which avoid the MMC closure scar. These techniques require dissection just distal to the apex of the gibbus; in the aforementioned case series, favorable complication rates over those of other techniques were reported.…”

“…These techniques require dissection just distal to the apex of the gibbus; in the aforementioned case series, favorable complication rates over those of other techniques were reported. 4,15…”

Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele?

“…Lumbar kyphosis is a complex spinal deformity occurring in approximately 8% to 20% of patients with myelomeningocele [ 8 , 14 , 21 ]. Kyphosis can progress from 6° to 12° per year after birth [ 2 , 3 , 6 , 24 ]. Worsening kyphosis is the result of incomplete formation of the posterior spinal elements, an imbalance in the paraspinal musculature anterior to the vertebral axis, unopposed action of the psoas muscle, and neurologic deficits caused by dysraphism [ 5 , 8 , 15 ].…”