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Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Kyphectomy in children with myelomeningocele
Haluk Altiok1, Craig Finlayson, Sahar Hassani
1Department of Orthopaedics, Shriners Hospital for Children-Chicago, 2211 North Oak Park Avenue, Chicago, IL 60707, USA. haltiok@shrinenet.org
Insights
Kyphectomy with spinal instrumentation effectively corrects and maintains spinal alignment in myelomeningocele patients. While technically demanding, this surgery offers significant deformity correction, though complications require careful management.
Area of Science:
- Spinal surgery
- Pediatric orthopedics
- Neurology
Background:
- Myelomeningocele often causes rigid kyphosis, leading to functional limitations and skin issues.
- Kyphectomy with spinal instrumentation is a surgical option for correcting this deformity.
Purpose of the Study:
- To evaluate fusion rates, deformity correction, and complications of kyphectomy with long segmental spinal instrumentation.
- To assess the Warner and Fackler technique for myelomeningocele kyphosis.
Main Methods:
- Retrospective review of 33 myelomeningocele patients undergoing kyphectomy and spinal instrumentation (1991-2006).
- Average age at surgery was 7.6 years; 21 patients had at least 2-year follow-up.
Main Results:
- Average kyphosis improved from 124° to 22°, an 81% correction.
- 17 postoperative complications occurred, primarily wound and skin issues.
- 11 secondary surgeries were performed in 10 patients.
Conclusions:
- Kyphectomy with posterior spinal fusion and instrumentation is effective for correcting and maintaining sagittal alignment in myelomeningocele.
- The procedure is technically demanding and associated with significant risks.
Background:
Patients with myelomeningocele and rigid lumbar and thoracolumbar kyphosis face substantial functional difficulties with sitting and lying supine and are prone to skin breakdown over the gibbus and risk of infection. Kyphectomy, along with cordotomy and segmental spinal instrumentation down to the pelvis, is one alternative that can provide reliable correction of the deformity but also can maintain that correction over a period of time.
Questions/Purposes:
We determined the fusion rates, deformity correction and maintenance, and perioperative complications of kyphectomy with long segmental spinal instrumentation using the Warner and Fackler technique.
Methods:
We retrospectively reviewed the charts and radiographs of 33 patients with myelomeningocele who had kyphectomy with segmental spinal instrumentation down to the pelvis between 1991 and 2006. The average age at surgery was 7.6 years (range, 3-19 years). Twenty-one patients had a minimum 2-year followup (average, 7.0 years; range, 2.4-15.7 years).
Results:
The average preoperative kyphosis of 124° (range, 75°-210°) improved at last followup to 22° (range, 3°-55°) with an average correction of 81% (range, 59%-98%). We identified 17 postoperative complications. Wound and skin complications were most common; 11 secondary surgeries were performed in 10 patients.
Conclusions:
Surgery for myelomeningocele kyphosis is technically demanding and carries substantial risk. Kyphectomy and posterior spinal fusion and instrumentation with the Warner and Fackler technique allow correction and maintenance of sagittal alignment.
