Authors: Thierry Odent Vincent Arlet Jean Ouellet Fabien Bitan
Publish Date: 2004/01/09
Volume: 13, Issue: 3, Pages: 206-212
Abstract
Rigid congenital kyphosis in myelomeningocele is associated with an important morbidity with skin breakdown recurrent infection and decreased function Kyphectomy is the classic treatment to restore spinal alignment however surgery is associated with an important morbidity and longterm correction is uncertain The authors retrospectively reviewed 9 patients with a mean age of 88 years who underwent a two stage surgical procedure first a posterior kyphectomy with a modified DunnMcCarthy fixation consisting of lumbar pedicle screws and long Sshape rods buttressing the anterior sacrum Then a second stage done several weeks later consisting of a thoracoabdominal approach to the spine with an inlay strut graft classically from T10–S1 The mean followup was 34 months range 1–5 years The kyphosis was corrected from a mean of 110° of Cobb angle range 70–130° to 15° after surgery 45–0° There was no instrumentation failure no loss of correction and no pseudarthrosis Complications consisted of one intraoperative cardiac arrest fortunately reversible a wound necrosis one deep venous thrombosis and one late aseptic bursitis on the posterior hardware Congenital kyphosis in myelomeningocele can be treated successfully with an initial posterior approach correction and instrumentation followed by an anterior approach allowing for anterior inlay impacted structural graft The authors believe that this technique improves biomechanical and biological fusion mass anteriorly and will prevent late instrumentation failure and loss of correction
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