Surgical correction of congenital kyphosis in myelomeningocele

A progressive kyphosis in myelomeningocele patients may occur when the lesion is in the lower thoracic spine (i.e., a high-level lesion). Previously described techniques for this difficult problem have been fraught with problems of loss of fixation, recurrent deformity, implant failure, and wound breakdown. The technique described involves resection of the apical vertebra and proximal portion of the gibbus followed by fixation with a single U-shaped rod implanted distally into the lumbosacral spine. The rod is fixed to the thoracic spine using the Luque technique. No wires are used distally and the sacroiliac joints are not violated. This paper presents the first four patients who have undergone this form of spinal surgery. To date these patients have maintained a satisfactory result, and there has been no implant failure. Although this is a small series and with a short follow-up, the results support the use of this technique.