Spinal Osteotomy for Severe Kyphosis in Children With Myelomeningocele

Eckstein, H.B.; Vora, Rushabh

doi:10.1302/0301-620x.54b2.328

Cited by 44 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many studies reported the number of complications experienced but did not comment on whether these complications were minor or if they required revision surgery. Perioperative mortality was encountered in five other series in the literature [2,5,20,[22][23][24][25]. This is not unexpected given the extensive surgical exposures required to perform kyphectomy in this already compromised population of patients.…”

Section: -Inchmentioning

confidence: 88%

“…Nonoperative treatment in the form of bracing, manual reduction, or observation to allow deformities to stabilize or the patient to reach skeletal maturity is often not successful [3,4,8,12,16,17,26,28]. Other indications include sagittal imbalance (such that the patient needs to use the upper extremities for sitting) [3,5,6,14,16,17,[26][27][28][29]31] and progressive deformity [6,10,11,13,21,31,34].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Comstock¹,

Cook

Leahey

et al. 2011

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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

show abstract

Section: -Inchmentioning

confidence: 88%

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

View full text Add to dashboard Cite

show abstract

“…In severe cases, an earlier intervention may be necessary to prevent severe deterioration. From 1968 on, a variety of surgical procedures has been described [1,5,7,8,10,21,24,[26][27][28][29]. Lindseth [17] recommends a simultaneous gibbus resection without instrumentation together with postpartal closure of the sac.…”

Section: Discussionmentioning

confidence: 99%

Sagittal static imbalance in myelomeningocele patients: improvement in sitting ability by partial and total gibbus resection

Fürderer¹,

Eysel²,

Hopf³

et al. 1999

European Spine Journal

View full text Add to dashboard Cite

IntroductionThe myelomeningocele (MMC) is one of the dysraphic disorders of the neural arch. Pathogenically it is caused by the absence of proliferation of neuroectodermal cells after migration is finished. The occult form without neurologic deficit is estimated to have incidence of up to 1%, while a spina bifida aperta cystica with everted myelon and complete paraplegia occurs in 0.005% of live births. With the help of postnatal closure of the sac and the early commencement of hydrocephalus therapy, the life expectancy of patients with myelomeningocele has nearly reached the level of the normal population [3,24]. While therapy during infancy concentrates on taking care of the cerebral and renal function, during growth and adolescence, more and more problems concerning the skeletal system arise, caused by the wish for maximum mobility and improved nursing aspects such as lying in supine position and sitting without support. The clinical appearance is dominated by the spastic or paralytic neurological lesion at different levels. In addition, the increasing spinal deformity in combination with trophic skin and soft tissue disturbances leads to secondary problems, i.e. decubital ulcers and contractures of hips and limbs. Kyphosis appears in 12-28% of the cases, with neurologic damage at the thoracic level [2,15,24, 25]. The gibbus, however, develops usually between L2 and L5 [4]. Problems of the kyphotic spineMyelomeningocele at the thoracic level is in most cases accompanied by other malformations of the neural arch. They can aggravate each other, if for example during progressive kyphosis the dura is pulled caudally by a tethered Abstract The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. The average kyphosis angle decreased from 128°to 81°, enabling most of the patients to participate again in social life by restoring wheelchair mobility. Nevertheless, a significantly higher complication rate was found compared to other correctional operations, lengthening the average hospital stay to 41 days. Special problems arose from trophic disorders of the skin and soft tissue and from the dystrophic muscles below the level of neural malfunction. In three cases, kyphosis reappeared cranial to the fused segments, requiring ventral stabilization. With respect to increasing kyphosis angle, an early intervention should be aimed at. A secondary operation can be necessary, if surgery is performed without taking care of the growth potential.

show abstract

“…6,8,38 Even via a posterior midline approach, the proximal ribs can be resected if needed. The surgical approach is a tool used to achieve a predetermined operative objective.…”

Section: Discussionmentioning

confidence: 99%

Treatment of subacute thoracic spine fracture-dislocation by total vertebrectomy and spine shortening

Barcelos¹,

Botelho

2013

SPI

View full text Add to dashboard Cite

show abstract

Spinal Osteotomy for Severe Kyphosis in Children With Myelomeningocele

Abstract: Newborn baby with severe kyphosis making skin closure impractical. FIG. 2 Chronic ulceration over a kyphos.

Cited by 44 publications

References 0 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

Sagittal static imbalance in myelomeningocele patients: improvement in sitting ability by partial and total gibbus resection

Treatment of subacute thoracic spine fracture-dislocation by total vertebrectomy and spine shortening

Contact Info

Product

Resources

About