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

摘要

>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. rules="all" class="rendered small default_table">>Methods evaluation and class of evidence (CoE)> valign="top" align="left" rowspan="1" colspan="1">Study design: valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Prospective cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Retrospective cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="left" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1">Methods valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Patients at similar point in course of treatment valign="top" align="left" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Follow-up ≥ 85% valign="top" align="left" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Similarity of treatment protocols for patient groups valign="top" align="left" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Patients followed-up long enough for outcomes to occur valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Control for extraneous risk factors rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">>Overall class of evidence valign="top" align="left" rowspan="1" colspan="1">IV> valign="top" align="left" colspan="2" rowspan="1">The definiton of the different classes of evidence is available on page 63. class="head no_bottom_margin" id="__sec1title">STUDY RATIONALEThoracolumbar kyphosis occurs in 10–20% of patients with myelomeningocele (MMC) ^,,.Curves are congenital and rigid, larger than 80° at birth and progressing to more than 100° . These lead to chronic pressure sores, impaired sitting balance, collapsing spine phenomena, decreased abdominal capacity, and reduced respiratory function . There is no consensus regarding the proper mode of correction in patients with MMC .