Kyphectomy with anterior column reconstruction using titanium mesh cage in meningomyelocele patients.

Mohammed Ali Hussien,Ahmed Elbadrawi,Mohammed Zayan

doi:10.1051/sicotj/2022006

Abstract

Study design: Prospective case series. Purpose: To describe a new technique for anterior column reconstruction after kyphectomy in myelomeningocele patients using titanium mesh cage and to evaluate outcomes and complications. Methods: Sixteen patients with severe dorsolumbar kyphosis 2ry to myelomeningocele were enrolled with a mean age of 10.1 years. Kyphectomy procedure and long spinopelvic fixation were done, titanium mesh cage was used to reconstruct the anterior column. Operative time and intraoperative blood loss were calculated. Using the Cobb method, pre and postoperative measurements of local/regional kyphosis were done. Degree and mean percentage of correction were calculated. Anterior intervertebral height of the kyphotic area was also measured. The mean follow-up period was 27 months. Results: Operative time was 271.3 min ± 25, and estimated intraoperative blood loss was 781.3 mL ± 92.3. On average, 2.5 vertebrae were resected. All 16 patients were able to lie supine immediately postoperatively. The mean preoperative local/regional kyphosis was 107.5°, and 106.9° respectively, corrected to 22.5° and 28.8° postoperatively, with a mean degree of correction of 85° and 78.1° respectively. Mean preoperative anterior intervertebral height was 3.54 cm, improved to 4.64 cm postoperatively. Only 2 cases had a superficial wound infection managed conservatively. At the latest follow-up, no loss of correction pseudoarthrosis occurred, and all patients showed solid fusion. Conclusion: Titanium mesh cage is an efficient, easy method for anterior reconstruction following kyphectomy in myelomeningocele patients, to maintain postoperative correction.Level of evidence: Therapeutic studies, Level IV study

Highlights

Severe rigid progressive kyphosis is a challenging problem in myelomeningocele patients
The purpose of this study is to develop a reliable and safe method for anterior reconstruction in these patients using the titanium mesh cage (TMC), which is an attractive alternative, being versatile in the shape, diameter and length, being hollow to accommodate morselized bone graft [7]
Sixteen myelomeningocele patients with severe rigid kyphosis were enrolled in this prospective study, patients mean age was 10.1 years ± 1.7

Summary

Introduction

Severe rigid progressive kyphosis is a challenging problem in myelomeningocele patients. A kyphotic deformed spine is present in 8–20% of these patients [1, 2]. This causes severe postural problems, inability to lie supine, pressure sores over the apex increasing the infection risk [1], and progressive loss of the ability to sit unassisted, which limits bimanual functions being used for truncal upright support [1]. Having unique features and comorbidities, the goals of and indications for surgery are different from other deformity patients where the primary surgical goal is the restoration of the child’s sitting balance [3, 4]. The secondary goals of surgical correction are to stop deformity progression, increase stability and halt

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Conclusion