Kyphectomy in children with myelodysplasia: results 1994-2004.
METHODS
We retrospectively studied 24 consecutive pediatric patients with lumbar kyphosis due to myelodysplasia who had received corrective surgical treatment with the Warner and Fackler technique from 1994 to 2004.


OBJECTIVE
The purpose of the study was to evaluate the technical problems and outcome and to identify complications of this treatment modality, especially regarding the biomechanics.


BACKGROUND
The management of lumbar kyphosis (8%-20%) in conjunction with myelodysplasia is difficult. In 1993, Warner and Fackler presented an elegant surgical technique, which was used here.


METHODS
Corrective surgery was performed in 24 patients with an average preoperative lumbar kyphosis of 124 degrees . The correction was achieved by kyphectomy combined with stabilization using rods and wires as described by Warner and Fackler. Outcome was rated and complications were identified using data from the clinical records. For biomechanical analysis of the surgical construct, a force model was developed.


RESULTS
The mean extent of lumbar kyphosis could be corrected from 124 degrees before surgery to 43 degrees after surgery. Biomechanical analysis showed that inadequate correction results in implant failure.


CONCLUSIONS
Surgery should always be performed with the intention to reestablish the sagittal profile inasfar as possible so as to reduce the risk of implant failure.
Akbar
Michael
M
Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany. Michael.Akbar@ok.uni-heidelberg.de
Bremer
Ralph
R
Thomsen
Marc
M
Carstens
Claus
C
Abel
Rainer
R
D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D009436:Neural Tube Defects / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome