Kyphectomy in children with myelomeningocele.
BACKGROUND
Patients with myelomeningocele and rigid lumbar and thoracolumbar kyphosis face substantial functional difficulties with sitting and lying supine and are prone to skin breakdown over the gibbus and risk of infection. Kyphectomy, along with cordotomy and segmental spinal instrumentation down to the pelvis, is one alternative that can provide reliable correction of the deformity but also can maintain that correction over a period of time.


OBJECTIVE
We determined the fusion rates, deformity correction and maintenance, and perioperative complications of kyphectomy with long segmental spinal instrumentation using the Warner and Fackler technique.


METHODS
We retrospectively reviewed the charts and radiographs of 33 patients with myelomeningocele who had kyphectomy with segmental spinal instrumentation down to the pelvis between 1991 and 2006. The average age at surgery was 7.6 years (range, 3-19 years). Twenty-one patients had a minimum 2-year followup (average, 7.0 years; range, 2.4-15.7 years).


RESULTS
The average preoperative kyphosis of 124° (range, 75°-210°) improved at last followup to 22° (range, 3°-55°) with an average correction of 81% (range, 59%-98%). We identified 17 postoperative complications. Wound and skin complications were most common; 11 secondary surgeries were performed in 10 patients.


CONCLUSIONS
Surgery for myelomeningocele kyphosis is technically demanding and carries substantial risk. Kyphectomy and posterior spinal fusion and instrumentation with the Warner and Fackler technique allow correction and maintenance of sagittal alignment.
Department of Orthopaedics, Shriners Hospital for Children-Chicago, 2211 North Oak Park Avenue, Chicago, IL 60707, USA. haltiok@shrinenet.org
Haluk
H
Altiok
Craig
C
Finlayson
Sahar
S
Hassani
Peter
P
Sturm
D000293:Adolescent; D002641:Chicago; D002648:Child; D002675:Child, Preschool; D002818:Cordotomy; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008591:Meningomyelocele / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult