Retrospective Review of Multilevel Spinal Fusion Combined With Spinal Cord Transection for Treatment of Kyphoscoliosis in Pediatric Myelomeningocele Patients

Abstract

Retrospective review of cases at a single institution from 1998 to 2005. The authors present their surgical experience, complications, and learned insight in 9 myelomeningocele children with kyphoscoliosis treated with combined spinal cord transection and spinal fusion. Complication rates in spinal fusion for treatment of kyphoscoliosis in myelomeningocele patients are high. Spinal cord transection in combination with fusion can be an appropriate strategy in selected patients, but changes in cerebrospinal fluid (CSF) dynamics that may accompany ligation of the distal CSF circulation are not well characterized. Demographic, clinical, and radiologic data were examined in 9 children with myelomeningocele level at or above T12 and no residual urologic function treated at our institution with spinal cord detethering and transection, and multilevel spinal fusion. Seven children underwent kyphectomy with posterior fusion only for severe gibbus deformities, while 2 had anterior and posterior fusions for severe kyphoscoliosis. Follow-up of patients ranged from 4 to 92 months (mean, 37.8 months). Eight children (89%) experienced postoperative complications involving wound infection or skin breakdown. One child presented with a CSF leak. Two children (22%) required revision of their ventriculoperitoneal shunts. The average angle of kyphosis before surgery was 122.3 (range, 48 degrees -180 degrees ), and the average postoperative angle was 38.2 (range, 4 degrees -113 degrees ), with average correction being 81.9 degrees (range, 29 degrees -124). Average correction of scoliosis, if present, was 59.5 degrees (range, 35 degrees -92 degrees ). Combined spinal cord transection and spinal fusion allowed an average correction of kyphosis by 81.9 degrees . The complication rate was 89%, with wound concerns being the most significant. Additionally, 22% of patients required shunt revision within 6 weeks of surgery. We attribute this to alteration of CSF dynamics resulting from loss of CSF absorption and flow-buffering capacity below the level of the spinal cord transection.