Long-term outcome of surgical correction of congenital kyphosis in patients with myelomeningocele (MMC) with segmental spino-pelvic fixation

Abstract

STUDY DESIGN A retrospective case series of patients with myelomeningocele (MMC) who underwent kyphectomy and posterior segmental fixation using Luque rods and 16-gauge wires. OBJECTIVE To assess outcomes after posterior kyphectomy and segmental fixation for kyphosis in patients with MMC. METHODS Thirteen consecutive patients who underwent posterior kyphectomy for transforaminal fixation contiguous to "everted lamina." Fusion rates, time to fusion, change in Cobb angle, complications, and improvement in activities of daily living using the Katz score were measured. RESULTS Average age at time of surgery was 9.2 (range, 4.5-17) years. Average time to follow-up was 120 (range, 20-310) months. Solid fusion was achieved in 9 patients (69%) with a mean time to fusion of 12 months. The mean postoperative kyphotic curve was 22° with an average correction of 90°. Five patients (38%) experienced a postoperative complication. The mean improvement in activities of daily living score was 1.6 points and all patients achieved independent sitting balance. CONCLUSION Segmental spino-pelvic fixation is a solid alternative mode of fixation in patients with MMC with congenital kyphosis. Patient selection, proper perioperative multidisciplinary assessment, and surgeons' expertise are significant in the success of this complex surgery.METHODS evaluation and class of evidence (CoE)STUDY DESIGN: Prospective cohort Retrospective cohort Case control Case series•METHODS Patients at similar point in course of treatment• Follow-up ≥ 85%• Similarity of treatment protocols for patient groups• Patients followed-up long enough for outcomes to occur Control for extraneous risk factorsOverall class of evidenceIVThe definiton of the different classes of evidence is available on page 63.