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Surgical treatment of vertebral deformity due to myelomeningocele
R Savini1, S Cervellati, N Bettini
1Centro Scoliosi, Istituto Ortopedico Rizzoli, Bologna.
Abstract:
Surgical treatment of vertebral deformity due to myelomeningocele has always presented important technical problems. Many complications, the foremost of which pseudarthrosis and infection, are reported in the literature. The authors discuss 14 patients with vertebral deformity from myelomeningocele who were treated with different surgical methods and reviewed after an average of eight years. The only conclusion that can be drawn on the basis of both the literature and the present study is that posterior surgery alone is incapable of guaranteeing stable correction over time for severe deformity. Combined anterior and posterior surgery with spinal fusion up to the sacrum yields better results, and the patient is not required to wear a corset afterward.
Insights
Surgical correction of severe vertebral deformities in myelomeningocele patients requires combined anterior and posterior spinal fusion. Posterior surgery alone is insufficient for long-term stable correction of these complex spinal conditions.
Area of Science:
- Orthopedic surgery
- Pediatric neurosurgery
- Spinal deformity correction
Background:
- Myelomeningocele frequently causes severe vertebral deformities.
- Surgical treatment of these deformities presents significant technical challenges.
- Complications such as pseudarthrosis and infection are common in the literature.
Purpose of the Study:
- To evaluate the long-term efficacy of different surgical methods for vertebral deformities in myelomeningocele.
- To compare the outcomes of posterior-only surgery versus combined anterior-posterior approaches.
Main Methods:
- Retrospective review of 14 patients with myelomeningocele-related vertebral deformity.
- Analysis of surgical treatments including posterior-only and combined anterior-posterior spinal fusion.
- Average follow-up of eight years.
Main Results:
- Posterior surgery alone did not provide stable correction for severe deformities over time.
- Combined anterior and posterior surgery with sacral fusion demonstrated superior results.
- Patients undergoing combined surgery did not require post-operative bracing.
Conclusions:
- Combined anterior and posterior spinal fusion is more effective for severe myelomeningocele-related vertebral deformities.
- This approach offers stable, long-term correction without the need for external bracing.
- Surgical strategy should consider combined techniques for optimal outcomes.
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