Surgical Management of Myelomeningocele-Related Spinal Deformities

• Published in: World neurosurgery Vol. 112; pp. e431 - e441
• Main Authors: Ryabykh, Sergey O., Pavlova, Olga M., Savin, Dmitry M., Burtsev, Alexander V., Gubin, Alexander V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Myelomeningocele-related spinal deformity; Post-myelomeningocele syndrome; Sharp-angled kyphosis; Post-myelomeningocele syndrome; MMC; MRI; Myelomeningocele-related spinal deformity; VAS; FIM; mJOA; Sharp-angled kyphosis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.01.058

To evaluate the optimal timing and type of surgical treatment of myelomeningocele (MMC)-related spinal deformities and long-term follow-up of surgical treatment. We reviewed and presented clinical pictures, treatment strategies and results of 20 patients with MMC-related spinal deformities treated at our center between 2010 and 2017. The average patient age was 6.3 years. The average preoperative neurologic status according to a modified Japan Orthopedic Association (mJOA) scale was 7.3 points (Benzel's modification). Average functional status was 41 points according to a functional independent measure scale (FIM). The average angle of kyphosis was 83.7°, that of scoliosis was 36.7°, and that of lordosis was 67° (Cobb angles). The average duration of surgery was 234 minutes, and the average total blood loss was 175 mL. The average angle of kyphosis correction was 61°, that of scoliosis correction was 25°, and that of lordosis correction was 25° (Cobb angles). The average duration of hospitalization was 16.6 days, and the average follow-up was 34.5 months. The total number of complications was 13. Reoperation was required in 9 cases. Neurologic status according to the mJOA scale improved by 0.6 point on average. Functional status according to the FIM increased by 6.6 points on average. Early surgical correction of MMC-related spinal deformities improves body balance and quality of life. The dual growing rod technique is safe and effective in cases of moderate neuromuscular spinal deformities at an early age. Kyphectomy is a challenging procedure with high complication rates, especially skin problems, but there are no alternative procedures for cases of heavy rigid kyphosis. •Progressive spinal deformity is a significant comorbidity associated with MMC. It leads to loss of truncal height and causes sitting, breathing, eating and urination difficulties due to increased chest and abdominal pressure.•We present our experience in 20 consecutive patients with different types of MMC-related spinal deformities.•A high incidence of spinal deformities is associated with thoracolumbar MMC.•The dual growing rod technique is safe and effective in cases of moderate neuromuscular spinal deformities at an early age.•Kyphectomy is the surgery of choice in cases with rigid MMC-related kyphosis, but it is associated with numerous complications, including skin and wound infection, nonfusion, and others.