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Prevalence of spinal deformities in myelomeningoceles treated in utero and postnatally, utilizing 3D external

Vinicius de Meldau Benites1,2, Vinicius Santos Baptista3, Matheus Galvão Valadares Bertolini Mussalem4

  • 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Rua Ibaiti, 145, São Paulo, SP, 03414-150, Brazil. drviniciusbenites@gmail.com.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|August 25, 2025
PubMed

Insights

In utero myelomeningocele (MMC) repair shows improved outcomes, with lower rates of scoliosis and urinary incontinence compared to postnatal surgery. This suggests a better overall prognosis for patients undergoing fetal MMC treatment.

Area of Science:

  • Pediatric Surgery
  • Fetal Medicine
  • Neurosurgery

Background:

  • Myelomeningocele (MMC) is a severe birth defect impacting the spinal cord.
  • Surgical repair is crucial, with options for in utero or postnatal intervention.
  • Spinal deformities and associated complications are significant concerns post-MMC repair.

Purpose of the Study:

  • To compare the prevalence of spinal deformities in patients who underwent in utero myelomeningocele (MMC) repair versus those who had postnatal surgery.
  • To evaluate differences in shunt requirement, incontinence, and other complications between the two surgical timing groups.

Main Methods:

  • Retrospective selection of 70 patients (2006-2021) treated for MMC.
  • Prospective external orthopedic system (EOS) imaging for patients under 18.
  • Radiographic analysis of scoliosis, pelvic parameters, and sagittal balance; comparison of birth metrics, shunt needs, and incontinence rates.

Main Results:

  • The in utero MMC repair group (47 patients) showed significantly lower rates of ventriculoperitoneal shunt requirement (p=0.001), scoliosis incidence (p=0.020), and urinary incontinence (p=0.009).
  • While Cobb angle did not differ significantly, the in utero group had lower axial pelvic rotation (p=0.024).
  • Patients undergoing in utero repair had lower birth weight and gestational age but similar age and gender distributions compared to the postnatal group.

Conclusions:

  • In utero MMC repair is associated with a reduced incidence of acquired scoliosis and lower rates of urinary incontinence.
  • Fetal surgical intervention for MMC appears to lead to a better overall prognosis, including decreased need for shunting.
  • These findings support the benefits of considering in utero repair for myelomeningocele.
Abstract

Keywords:
Congenital abnormalitiesMyelomeningocelePediatricsScoliosisSurgical procedures

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