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Complications and outcomes of spinal deformity correction in patient with open neural tube defects
Olga M Sergeenko1, Dmitry M Savin2, Yulia S Arestova3
1Division of Spinal Surgery, Ilizarov Center, 6, M. Ulyanova Street, Kurgan, 640014, Russia. pavlova.neuro@mail.ru.
Purpose:
To evaluate surgical complications, functional and neurological outcomes of spinal deformity correction in children who underwent open neural tube defects (ONTDs) repair earlier.
Methods:
We analyzed 65 patients with treated ONTDs (myelomeningocele and myeloschisis) who underwent spinal deformity correction at a single center from 2010 to 2023. Statistical methods included logistic regression to assess predictors of early and late complications.
Results:
Higher level of spinal cord malformation and spina bifida associated with higher rate of non-ambulatory status, C-shaped thoracolumbar scoliosis, lumbar kyphosis rate, and severity. Early complications occurred in 37% and included wound problems (31%), pneumothorax (6%), and screw malposition (5%). Late complications were noted in 39%, including late-onset implant exposure through skin (32%), rod fracture (14%), and screw loosening (10%). Intraoperative blood loss correlated with early wound complications (p = 0.004, OR 1.01, 95% CI 1.01-1.02) and pelvic fixation correlated with pseudoarthrosis (p = 0.027, OR 7.13, 95% CI 1.25-40.79). Neurological function remained stable during follow-up, whereas functional independence improved, but much less than in healthy individuals.
Conclusions:
Level of spinal cord malformation in ONTDs correlated with walking status and deformity type and severity. Spinal deformity correction after ONTDs repair carries a high complication rate. Surgical intervention likely does not affect neurological and functional status significantly, but functional independence gradually improves.
Insights
Spinal deformity correction in children with open neural tube defects (ONTDs) repair has a high complication rate. While neurological status remains stable, functional independence shows gradual improvement post-surgery.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Open neural tube defects (ONTDs) often lead to spinal deformities.
- Previous surgical repair of ONTDs can influence outcomes of subsequent spinal deformity correction.
Purpose of the Study:
- To evaluate surgical complications.
- To assess functional and neurological outcomes.
- To analyze outcomes of spinal deformity correction in children with a history of ONTDs repair.
Main Methods:
- Retrospective analysis of 65 patients with treated ONTDs (myelomeningocele, myeloschisis).
- Spinal deformity correction performed between 2010 and 2023.
- Logistic regression used to identify predictors of complications.
Main Results:
- Higher spinal cord malformation levels correlated with worse ambulatory status and increased deformity severity.
- Early complications (37%) included wound issues and screw malposition; late complications (39%) involved implant exposure and rod fracture.
- Intraoperative blood loss predicted wound complications; pelvic fixation correlated with pseudoarthrosis.
Conclusions:
- Spinal cord malformation level impacts walking ability and deformity characteristics.
- Spinal deformity correction in ONTDs patients has a significant complication rate.
- Surgery has minimal impact on neurological and functional status, though functional independence improves over time.
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