Complications, Results, and Risk Factors of Spinal Fusion in Patients With Myelomeningocele

Abstract

Study DesignRetrospective prognostic study. ObjectiveThe purpose of this study assess was to assess the results of spinal fusion and identify factors associated with the development of post–spinal fusion infections in patients with myelomeningocele. BackgroundSurgical correction of neuromuscular scoliosis secondary to myelomeningocele is known to be associated with a high complication rate. MethodsA retrospective cohort study design was used to collect data on patients with myelomeningocele who underwent spinal fusion between the years of 1997–2013. Only subjects with a minimum of two years of continuous follow-up were included in the study. Demographic, surgical, clinical, and radiographic variables of interest were collected. Univariate and multivariable logistic regression analyses were used to identify factors predictive of an infection. Linear mixed model regression analyses were used to analyze postsurgical changes in radiographic parameters. ResultsOf the 33 subjects included in the study, 33.3% developed a postoperative infection. Overall, 69.0% of patients achieved a >50% correction of primary curvature at the one-month time point. Of the measured variables, lumbar and thoracolumbar kyphosis (odds ratio: 10.9, 95% confidence interval [CI]: 1.2-158.3, p = .0465) and a low preoperative hematocrit odds ratio per 1% increase, 0.7 (95% CI: 0.5-0.9, p = .0145) were associated with developing a postoperative infection. There was a significant improvement in the proportion of subjects with a pelvic obliquity measurement <5° one month postsurgery (p = .0339), kyphosis (p = .0401), and Cobb angle of the primary curvature across all time points (p <.0001). ConclusionType of procedure, neurosegmental level, transfusion rates, age at surgery, gender, length of operation, preoperative urinary tract infection, estimated blood loss, and the number of levels fused were not modifiable risk factors for future complications for patients with scoliosis secondary to myelomeningocele, whereas lumbar and thoracolumbar kyphosis or low hematocrit levels may lead to an increased risk for developing a postspinal fusion infection. Level of EvidenceLevel II.