Kyphectomy in the treatment of patients with myelomeningocele

Abstract

Background context Myelomeningocele kyphosis is a complex disorder that usually requires surgical intervention. Many complications can occur as a result of this disorder and its treatment, but only surgical correction offers the possibility of restoring spinal alignment. Purpose The purpose of this retrospective study was to summarize the surgical results, complications, and short-term and midterm outcomes for surgical correction of severe kyphosis using a consistent surgical technique. Study design This was a retrospective review of our database of pediatric patients with myelomeningocele and lumbar kyphosis who underwent kyphectomy with the use of the Warner and Fackler technique. Patient sample Eleven pediatric kyphectomy cases performed by a single surgeon from 1984 to 2009 were reviewed. Outcome measures Outcome measures include imaging, kyphotic angle measurement, and physical examination. Methods Patients underwent the Warner and Fackler technique of posterior-only kyphectomy and bayonet-shaped anterior sacral fixation. Results The mean extent of kyphosis was 115.6° (range, 77–176°) preoperatively with a correction to 13.0° (range, 0–32°) postoperatively, and a reduction with an average of 102.6° (range, 65–160°), for an 88.7% correction. On an average, 2.0 (range, 1–6) vertebrae were resected. Immediately postoperatively and at follow-up, with an average of 67.2 months (range, 8–222 months), the average kyphosis angle was 13.0° (range, 0–32°). All patients undergoing the procedure were unable to lie supine preoperatively. All patients postoperatively could lie in the supine position. The functional outcome in patients and caretakers was rated very favorably because all patients and caretakers who provided feedback (9 of 11) reported that they were satisfied with the procedure and would undergo the procedure again if given the choice. Conclusions This technique has become the most effective surgical reconstruction in myelomeningocele kyphosis. Although significant complications can occur during and after the procedure, most patients had satisfactory postoperative outcomes and restoration of sagittal balance with high patient and parent satisfaction