Surgical Management of Hip Problems in Myelomeningocele: A Review Article
Taghi Baghdadi1, Reza Abdi1, Ramin Zargar Bashi1
1Emam Educational Hospital, Tehran University of Medical Science, Tehran, Iran.
Insights
Treating hip problems in children with myelomeningocele (MMC) remains challenging. Muscular balancing, with or without surgery, appears to be a reasonable approach for hip dislocation in unilateral mid-lumbar MMC.
Area of Science:
- Pediatric Orthopedics
- Spinal Cord Defect Management
Background:
- Children with myelomeningocele (MMC) frequently experience diverse hip deformities, including muscle imbalance, contracture, subluxation, and dislocation.
- Existing treatments for hip issues in MMC lack comparative studies or meta-analyses to evaluate outcomes and complications.
Purpose of the Study:
- To identify the most effective treatment approach for hip problems in patients with myelomeningocele (MMC).
Main Methods:
- A comprehensive literature search of MEDLINE was conducted up to April 2015.
- Studies of all designs reporting on hip problems in MMC were included.
- 55 relevant studies focusing specifically on hip problems in MMC were selected and reviewed from 270 screened citations.
Main Results:
- Complex reconstructive procedures for hip dysplasia and muscle balancing in MMC patients are seldom indicated when quadriceps power is insufficient.
- The review highlights the rarity of indications for complex osseous and soft tissue procedures in MMC patients lacking adequate quadriceps strength.
Conclusions:
- A definitive consensus on the optimal treatment algorithm for hip dislocation in myelomeningocele has been absent.
- Muscular balancing, potentially combined with osseous procedures, is suggested as a viable strategy, particularly for unilateral mid-lumbar MMC cases.
Background:
Children with myelomeningocele (MMC) develop a wide variety of hip deformities such as muscle imbalance, contracture, subluxation, and dislocation. Various methods and indications have been introduced for treatment of muscle imbalances and other hip problems in patients with MMC but there is no study or meta-analysis to compare the results and complications. This review aims to find the most acceptable approach to hip problems in patients with MMC.
Methods:
MEDLINE was searched up to April 2015. All study designs that reported on the outcomes of hip problems in MMC were included. From 270 screened citations, 55 were strictly focused on hip problem in MMC were selected and reviewed.
Results:
Complex osseous and soft tissue reconstructive procedures to correct hip dysplasia and muscle balancing around the hip are rarely indicated for MMC patients without good quadriceps power.
Conclusion:
Over the years a consensus on the best algorithm for treatment of hip dislocation in myelomeningocele has been missing, however, muscular balancing with/out osseous procedure seems a reasonable approach especially in unilateral mid-lumbar MMC.
