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Kyphectomy and Segmental Spinal Fusion in Children with Myelomeningocele Kyphosis: E‐Poster #22

Altiok, Haluk MD; Finlayson, Craig J. MD; Sturm, Peter F. MD (Shriners Hospitals for Children); Hammerberg, Kim MD; Hassani, Sahar MS

Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 170–171
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Introduction: The prevalence of rigid kyphosis of the lumbar spine in myelomeningocele patient ranges from 8% to 15% depending on the series. The deformity is progressive in all cases and is recalcitrant to nonsurgical treatment. Progression of these curves can range from 4° to 12° per year. Skin breakdown, poor balance and support and related sitting problems, compression of the abdominal contents, and respiratory compromise are usually the leading indications for surgical treatment. Kyphectomy and segmental spinal fusion is not only technically challenging but also associated with significant risks and complications.

Methods: This was a retrospective study of patients with myelomeningocele kyphosis who were treated with kyphectomy and segmental spinal fusion. 33 patients underwent the procedure over a 16 year period. Complete chart and radiological reviews were available for 21 patients who had at least 2 year follow‐up.

Results: Average age for the study group at the time of surgery was 8 years (range, 3–19 years). All patients were thoracic level except one with Ll level. Skin breakdown was the most common indication for surgery and was noted in 17 of 21 patients. Pelvic fixation was carried out with a modified Dunn‐McCarthy technique in 20 patients. Estimated blood loss average was 739cc. There was one death intra‐operatively. Skin and wound healing problems were encountered in 9 patients. Pseudoarthrosis was present in 5 of the patients. Hardware failure was noted in 6 patients, 3 of whom had a pseudoarthrosis. The initial kyphosis (average 123°) was reduced to 22.5° (range 4° to 70°) with an average improvement of 82%. Kyphosis correction at final follow‐up was 79.5%. The average decrease in lordosis was 47% (0–82%). At final follow‐up, the average lordosis was 33.8°.

Conclusion: Surgical correction of myelomeningocele kyphosis is a technically challenging operation with potential peri and post operative complications. Despite this, surgical correction of the deformity and maintenance of the correction is possible with excellent pelvic fixation using the modified Dunn‐McCarthy technique.

Significance: This study provides information in regards to the management of myelomeningocele kyphosis based on the experience of a single institute over 16 year period.

© 2009 Lippincott Williams & Wilkins, Inc.