The surgical treatment of spinal deformity in children with non-ambulatory myelomeningocele.

Abstract

AIMS:

To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.

METHODS:

We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire.

RESULTS:

The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar deformity. Mean scoliosis corrected from 89.6° (47° to 151°) to 46.5° (17° to 85°; p < 0.001). Mean kyphosis corrected from 79.5° (40° to 135°) to 49° (36° to 65°; p < 0.001). Mean pelvic obliquity corrected from 19.5° (8° to 46°) to 9.8° (0° to 20°; p < 0.001). Coronal and sagittal balance restored to normal. Complication rate was 58.3% (seven patients) with no neurological deficits, implant failure, or revision surgery. The degree of preoperative spinal deformity, especially kyphosis and lordosis, correlated with increased blood loss and prolonged hospital/intensive care unit stay. The patients reported improvement in function, physical appearance, and pain after surgery. The parents reported decrease in need for everyday care.

CONCLUSION:

Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. This resulted in physical and functional improvement and high reported satisfaction. Cite this article: Bone Joint J 2021;103-B(6):1133-1141.

• Authors: Athanasios I Tsirikos, Sarah J Wordie
• Journal: The bone & joint journal (Bone Joint J) Vol. 103-B Issue 6 Pg. 1133-1141 (Jun 2021) ISSN: 2049-4408 [Electronic] England
• PMID: 34058879 (Publication Type: Journal Article)

Topics

• Adolescent
• Child
• Female
• Humans
• Kyphosis (etiology, surgery)
• Male
• Meningomyelocele (complications)
• Scoliosis (etiology, surgery)
• Scotland
• Spinal Fusion (methods)
• Surveys and Questionnaires