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Updated: Apr 6, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Evolving surgical strategies in myelomeningocele (MMC): shift toward index fusion with stable complication rates
Edwin S Kulubya1, Matthew J Weintraub2, Omar Taha3
1Boston Children's Hospital, Boston, MA, USA.
Purpose:
This study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes.
Methods:
A retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into "early vs. late" groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann-Whitney U, chi-square, and Cochran-Armitage trend tests.
Results:
The cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63%) experienced major complications (MCDS ≥ III), predominantly wound-related (79). The late group was older at index surgery (6.7 vs. 7.7 years, p = 0.031) and had a higher rate of index fusion (7.5% vs. 20.2%, p = 0.022). Preoperative and postoperative radiographic parameters were similar. Among GF patients, 71 underwent definitive spinal fusion. On average, patients treated with VEPTR/TGR underwent 5 lengthening procedures, while those treated with MCGR underwent 8. Across all GF patients, the average number of unexpected reoperations was 1.6. Overall five-year complication rates did not differ significantly between early and late cohorts (66.7% vs. 60.6%; p > 0.05). A declining trend in complication rates over time was observed (p = 0.082).
Conclusions:
From 2002-2019, surgical management of MMC evolved toward increased index fusion and older age at index, possibly to reduce repeat surgery risks. Despite this, radiographic outcomes and overall complication rates were similar between early- and late-era cohorts, and a downward trend in complications that approached statistical significance was observed over time.
Level Of Evidence:
IV.
Insights
Surgical management for myelomeningocele (MMC) evolved towards earlier fusion, but complication rates remained similar over time. A trend towards fewer complications was observed, suggesting improving surgical outcomes for spinal conditions.
Area of Science:
- Spine Surgery
- Pediatric Orthopedics
- Myelomeningocele Management
Background:
- Myelomeningocele (MMC) often requires complex spinal surgeries.
- Understanding trends in surgical management and outcomes is crucial for improving patient care.
- Previous studies have highlighted significant complication rates in MMC patients undergoing spinal procedures.
Purpose of the Study:
- To examine trends in the surgical management of myelomeningocele (MMC) patients.
- To analyze complications and radiographic outcomes in MMC patients undergoing spine surgery.
- To compare outcomes between early and late surgical eras for MMC.
Main Methods:
- Retrospective review of a multicenter registry including 187 MMC patients.
- Data collected on demographics, surgery type, ambulatory status, and radiographic parameters.
- Complications were recorded using the Modified Clavien-Dindo-Sink (MCDS) scale and analyzed over five-year intervals.
Main Results:
- 63% of patients experienced major complications (MCDS ≥ III), primarily wound-related.
- The late surgical group was older at index surgery and had a higher rate of index fusion.
- Overall five-year complication rates did not differ significantly between early and late cohorts, with a trend towards declining complications over time.
Conclusions:
- Surgical management of MMC evolved towards increased index fusion and older age at surgery between 2002-2019.
- Radiographic outcomes and overall complication rates remained similar between early and late cohorts.
- A statistically approaching downward trend in complications suggests potential improvements in surgical care for MMC.
