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Posterior psoas transfer and hip instability in lumbar myelomeningocele
Insights
Posterior psoas transfer surgery significantly improves hip stability in children with lumbar myelomeningocele. Functional outcomes are linked to neurological level, with optimal timing crucial for best results.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Rehabilitation Medicine
Background:
- Myelomeningocele, a severe birth defect, often leads to hip instability and functional deficits in children.
- Posterior psoas transfer is a surgical technique aimed at improving hip stability and ambulation in affected individuals.
Purpose of the Study:
- To evaluate the long-term efficacy of posterior psoas transfer in children with lumbar myelomeningocele.
- To assess the impact of the procedure on hip stability and functional outcomes.
Main Methods:
- A retrospective review of 72 posterior psoas transfer operations in 44 children with lumbar myelomeningocele.
- Assessment included muscle charting for walking ability and radiographic hip examination, with follow-up ranging from one to eight years.
Main Results:
- Significant improvement in hip stability was observed, increasing from 49% pre-operatively to 94% at follow-up.
- Acceptable functional results were achieved in 57% of the children, primarily dependent on the level of neurological activity.
- Optimal surgical timing is recommended around nine months of age, with specific indications for older children.
Conclusions:
- Posterior psoas transfer is an effective procedure for enhancing hip stability in pediatric myelomeningocele.
- Functional success is closely correlated with pre-existing neurological function.
- Recommendations are provided for patient selection and optimal timing of the surgical intervention.
Abstract:
Seventy-two posterior psoas transfer operations performed in forty-four children with lumbar myelomeningocele were reviewed one to eight years after operation in an attempt to assess its value. Muscle charting, an objective recording of the child's walking ability, and radiographic examination of the hips were done. Hip stability was improved: 49 per cent were stable at the time of psoas transfer and 94 per cent at review. Functional results depend mainly on the level of neurological activity present: 57 per cent of the children had an acceptable functional result. Usually, posterior psoas transfer should be done as soon after the age of nine months as the child's condition will allow. Over the age of two years it should be restricted to children with activity in the third and fourth segments of the lumbar cord.