Early kyphectomy in myelomeningocele: insights from a paediatric case series

Myelomeningocele (MMC) can lead to spinal deformities such as lumbar kyphosis, which can cause complications like skin ulcers, respiratory issues, and increased abdominal pressure. While kyphectomy is a treatment option, the role of instrumentation and the timing of surgery in children, particularly in neonates and infants, remains debated. This study describes the outcome of different age-adjusted surgical strategies in a paediatric MMC cohort, including kyphectomy-only surgery in neonates and infants.

A retrospective case series of six patients with MMC-associated kyphosis was reviewed. Surgical strategies were individualized based on patient age and radiological features, with cases being managed with or without instrumentation. Data collected included preoperative kyphosis angle, surgical approach, blood transfusion requirements, postoperative kyphosis angle, and follow-up duration. A literature review was also conducted to contextualize the findings.

The cohort included two older children, one toddler, two neonates, and one infant. Older patients required kyphectomy with instrumentation due to significant deformities and postoperative instability. Neonates undergoing combined MMC repair and kyphectomy achieved satisfactory kyphosis correction without instrumentation, with minimal complications. The 2-year-old patient, initially treated without instrumentation, required a second surgery due to worsening kyphosis. The associated literature review supports our suggestion that early kyphectomy, particularly in neonates, can effectively prevent kyphosis progression without instrumentation, although recurrence remains a concern.

Early kyphectomy, especially in neonates, may be an effective treatment for MMC-related kyphosis, achieving satisfactory spinal alignment and preventing complications of progressive deformity. However, the risk of recurrence and the age threshold for kyphectomy-only surgery are not yet well defined, suggesting that additional research is needed. Larger, prospective studies are necessary to better define the optimal timing and long-term outcomes of this approach.