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Kyphectomy in neonates with meningomyelocele

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Abstract

Purpose

Kyphosis is the most severe spinal deformity associated with meningomyelocele (MMC) and is seen in approximately 15% of neonates. Our purpose is to present our clinical experience, to discuss the technique and deformity correction in kyphectomy in neonates with MMC, and to assess its long-term outcomes.

Method

In this prospective study, the authors reviewed eight cases submitted to surgery between 2013 and 2015. We evaluated clinical characteristics that were analyzed, as were the operative technique employed, and angle range of the kyphosis deformity postcorrection follow-up.

Results

Neonatal kyphectomy was performed of six females and two males. The mean birth weight was 2780 g, and the mean age at the time of surgery was 5.6 days. There were S-shaped type deformity in lumbar region in all neonates. In the correction of the kyphotic deformity, a total vertebrae were removed from four patient, whereas a partial vertebrectomy was done in four. The mean operative time was 116 min. No patients did not require the blood transfusion. There were no serious complications, and wound closure was successful in all patients. The mean follow-up period was 4 years and 3 months (range 36–61 months), except one patient who died 1 week after discharge. The mean preoperative kyphosis of 75.6° (range, 50°-90°) improved at last follow-up to 35° (range 15°–55°). All patients had surgical procedures for hydrocephalus. Three patients had surgery for Chiari type II malformation. The mean hospital stay was 27.7 days.

Conclusion

Kyphectomy performed at the time of dural sac closure in the neonate is a safe procedure with excellent correction.

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References

  1. Banta JV, Hamada JS (1976) Natural history of the kyphotic deformity in myelomeningocele. J Bone Joint Surg Am 58:279

    Article  Google Scholar 

  2. Bartonek A, Saraste H (2001) Factors influencing ambulation in myelomeningocele: a cross-sectional study. Dev Med Child Neurol 43:353–260

    Article  Google Scholar 

  3. Christofersen MR, Brooks AL (1985) Excision and wire fixation of rigid myelomeningocele kyphosis. J Pediatr Orthop 5:691–696

    Article  CAS  PubMed  Google Scholar 

  4. Crawford AH, Strub WM, Lewis R, Gabriel KR, Billmire DA, Berger T, Crone K (2003) Neonatal kyphectomy in the patient with myelomeningocele. Spine 28:260–266

    PubMed  Google Scholar 

  5. Doers T, Walker JL, van den Brink KD, Stevens DB, Heavilon J (1997) The progression of untreated lumbar kyphosis and compensatory thoracic lordosis in myelomeningocele. Dev Med Child Neurol 39:326–330

    CAS  PubMed  Google Scholar 

  6. Duddy JC, Caird J, Connolly P (2013) Repair of a large thoracolumbar myelomeningocele with associated lumbar kyphosis. Acta Neurochir 155:1965–1968

    Article  PubMed  Google Scholar 

  7. Eckstein HB, Vora RM (1972) Spinal osteotomy for severe kyphosis in children with myelomeningocele. J Bone Joint Surg Br 54:328–333

    Article  CAS  PubMed  Google Scholar 

  8. Gepp RA, Quiroga MRS, Gomes CR, Araujo HJ (2013) Kyphectomy in meningomyelocele children: surgical technique, risk analysis, and improvement of kyphosis. Child Nerv Syst 29:1137–1141

    Article  Google Scholar 

  9. Guille JT, Sarwark JF, Sherk HH, Kumar SJ (2006) Congenital and developmental deformities of the spine in children with meningomyelocele. J Am Acad Orthop Surg 14:294–302

    Article  PubMed  Google Scholar 

  10. Karlin MI (2007) Kyphectomy for myelodysplasia. Neurosurg Clin N Am 18:357–364

    Article  PubMed  Google Scholar 

  11. Lindseth RE, Stelzer L (1979) Vertebral excision for kyphosis in children with myelomeningocele. J Bone Joint Surg Am 61:699–704

    Article  CAS  PubMed  Google Scholar 

  12. Martin J, Kimar SJ, Guille JT, Ger D, Gibbs M (1994) Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment. J Pediatr Orthop 14:323–328

    Article  PubMed  Google Scholar 

  13. Lindseth RE (1991) Spine deformity in myelomeningocele. Instr Course Lec 40:273–286

    Google Scholar 

  14. Linther SA, Lindseth RE (1994) Kyphotic deformity in patients who have a myelomeningocele. J Bone Joint Surg Am 76:1302–1307

    Google Scholar 

  15. Lowe GP, Menelaus MB (1978) The surgical management of kyphosis in older children with myelomeningocele. J Bone Joint Surg Br 60:40–45

    Article  CAS  PubMed  Google Scholar 

  16. Marreiros H, Loff C, Calado E (2015) Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. J Spinal Cord Med 38:626–640

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mintz LJ, Sarwark JF, Dias LS, Schafer MF (1991) The natural history of congenital kyphosis in myelomeningocele: a review of 51 children. Spine 16:S348–S350

    Article  CAS  PubMed  Google Scholar 

  18. Sharrard WJW (1968) Spinal osteotomy for congenital kyphosis in myelomeningocele. J Bone Joint Surg Br 50:466–471

    Article  CAS  PubMed  Google Scholar 

  19. Sharrard WJW, Drennan JC (1972) Osteotomy-excision of the spine for lumbar kyphosis in older children with myelomeningocele. J Bone Joint Surg Br 54:50–60

    Article  CAS  PubMed  Google Scholar 

  20. Yoshioka K, Watanabe K, Toyama Y, Chiba K, Matsumoto M (2011) Kypectomy for severe kyphosis with pyogenic spondylitis associated with myelomeningocele: a case report. Scoliosis 6:5

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Nail Özdemir.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Özdemir, N., Özdemir, S.A. & Özer, E.A. Kyphectomy in neonates with meningomyelocele. Childs Nerv Syst 35, 673–681 (2019). https://doi.org/10.1007/s00381-018-4006-4

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