Treatment Of Scoliosis In Children Research Articles

Urological Problems After Surgical Treatment of Scoliosis in Children with Myelomeningocele

Urological Problems After Surgical Treatment of Scoliosis in Children with Myelomeningocele

Urological Problems After Surgical Treatment of Scoliosis in Children with Myelomeningocele

Purpose We assessed urological problems and complications after scoliosis surgery in children with myelomeningocele. Materials and Methods A total of 16 children with myelodysplasia underwent surgery for scoliosis using different surgical techniques and instrumentation systems. Mean patient age at operation was 11 years and mean postoperative followup was 3 years. All patients had urological assessment before and after surgery, including urodynamics. Results Urological problems after surgical correction of scoliosis developed in 6 patients (38 percent). Three girls had difficulty performing clean intermittent self-catheterization postoperatively because of altered body posture, a genital pressure sore and a plaster body cast, respectively. In 4 patients, including 1 girl with problems performing clean intermittent self-catheterization, lower urinary tract function was altered, leading to upper urinary tract deterioration in 1 and worsening of urinary incontinence in 3. Conclusions Children with myelomeningocele have a high incidence of urological complications after surgical treatment of scoliosis. Anticipation of the problems and a thorough postoperative urological evaluation, including urodynamics, can reduce morbidity and facilitate appropriate treatment.

Brace treatment of scoliosis in children with myelomeningocele.

In twenty-one children with myelomeningocele and progressive scoliosis, treatment of scoliosis was attempted with a Boston type underarm brace. Thirteen children finished full brace treatment (average treatment time 2.5 years) and the patients were included in a follow-up more than 2 years after the end of treatment with no further progression of the scoliosis. Two patients are still undergoing brace treatment. Six children were operated due to continued progression of the scoliosis. Among 14 patients with scoliosis 45 degrees or less at the start of brace treatment, only 1 patient progressed and underwent operation. The brace had a temporary effect on severe scoliosis, decreasing the rate of progression. Complications were few. The brace caused decubitus ulcer in one patient, and two patients developed increased pressure of the urinary tract.