Complications, Results, and Risk Factors of Spinal Fusion in Patients With Myelomeningocele

Ollesch, Bridget; Brazell, Christopher; Carry, Patrick M.; Georgopoulos, Gaia

doi:10.1016/j.jspd.2017.12.015

Cited by 12 publications

(10 citation statements)

References 39 publications

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“…Выраженные вторичные изменения позвонков усложняют интерпретацию лучевых данных (КТ), в связи с чем для планирования операции рекомендуют применять 3D-модели позвоночника [12,19,20]. При этом кифэктомии с удалением от одного до пяти позвонков [21] и многоуровневой стабилизацией позвоночника [22] металлоконструкции [14,23] и переломами ее элементов [23], формированием псевдоартроза [24], дисфункцией имеющегося вентрикулоперитонеального шунта [22]. Значительную часть таких пациентов в дальнейшем оперируют неоднократно [14].…”

Section: Discussionunclassified

Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review

et al. 2022

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Objective. To analyze immediate results of meningomyelocele closure with simultaneous kyphectomy in newborns.Material and Methods. In two newborns, correction of kyphosis by vertebrectomy and decancellation of the apical vertebral body was performed simultaneously during surgery for meningomyeloceleResults. In both cases, extensive mobilization of soft tissues to close the skin defect was not required, while a significant correction of kyphoticdeformity was noted. The postoperative wound healed by primary intention on days 9–11. The follow-up period was 11 and 8 months.Only 34 such operations in newborns were reported in the literature. All the authors noted the absence of postoperative wound complications typical for meningomyelocele repair without an orthopedic stage. In small series with a long follow-up period there was a gradual loss of correction after such operations, but without the formation of angular kyphosis requiring repeated kyphectomy.Conclusion. Kyphectomy in newborns with meningomyelocele provided the possibility of effective closure of the skin defect and uncomplicated healing of the postoperative wound.

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Section: Discussionunclassified

Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review

et al. 2022

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“…The similarity of the Cobb Angle in the pre-and post-protocol groups (74° and 75°) corroborates published findings on the need for surgical intervention in cases where there is a high degree of curvature. 16,17 Miladi et al, 18 report, in their study, that surgically treated neuromuscular scoliosis patients had a mean Cobb angle of 89º. Regarding the baseline diagnosis, cerebral palsy followed by myelomeningocele continued to be the most prevalent pathologies in the samples, as well as in the studies by Brooks et al, 11 and Obid et al, 19 who confirm the fact that patients with cerebral palsy (Gross Motor Function Classification System levels IV and V) have a high risk of developing scoliosis, with a 95% chance of curve progression.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Patients Undergoing Correction of Neuromuscular Scoliosis With a Controlled Hospital Protocol – Preliminar Outcomes

et al. 2021

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Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

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“…Management of orthopaedic conditions is contingent upon the level of disease. Nonoperative treatments include bracing and orthotics [5,6], and severe cases in higher functioning patients may be addressed with surgical management [7,8].…”

Section: Introductionmentioning

confidence: 99%

Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele

Swarup

Talwar

Howell

et al. 2020

Journal of Pediatric Orthopaedics B

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Myelomeningocele, characterized by extrusion of the spinal cord through a spinal canal defect, is the most common form of spina bifida, often resulting in lifelong disability and significant orthopaedic issues. A randomized controlled trial (RCT) has shown the efficacy of prenatal repair in decreasing the need for shunting and improving motor outcomes. However, no studies have evaluated the effects of prenatal repair on orthopaedic outcomes. The purpose of this study was to determine the rates of orthopaedic conditions in patients with prenatal and postnatal repair of myelomeningocele and compare the rates of treatment required. This study analyzes the relevant outcomes from a prospective RCT (Management of Myelomeningocele Study). Eligible women were randomized to prenatal or postnatal repair, and patients were evaluated prospectively. Outcomes of interest included rates of scoliosis, kyphosis, hip abnormality, clubfoot, tibial torsion, and leg length discrepancy (LLD) at 12 and 30 months. The need for orthopaedic intervention at the same time points was also evaluated. Statistical analyses included descriptive statistics and univariate analyses. Data for the full cohort of 183 patients were analyzed (91 prenatal, 92 postnatal). There were no differences in rates of scoliosis, kyphosis, hip abnormality, clubfoot or tibial torsion between patients treated with prenatal or postnatal repair. The rate of LLD was lower in the prenatal repair group at 12 and 30 months (7 vs. 16% at 30 months, P = 0.047). The rates of patients requiring casting or bracing were significantly lower in patients treated with prenatal repair at 12 and 30 months (78 vs. 90% at 30 months, P = 0.036). Patients treated with prenatal myelomeningocele repair may develop milder forms of orthopaedic conditions and may not require extensive orthopaedic management.

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Complications, Results, and Risk Factors of Spinal Fusion in Patients With Myelomeningocele

Abstract: Level II.

Cited by 12 publications

References 39 publications

Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review

Kyphosis correction as an option for surgical treatment of meningomyelocele in a newborn: immediate results of two clinical cases and literature review

Clinical Outcomes of Patients Undergoing Correction of Neuromuscular Scoliosis With a Controlled Hospital Protocol – Preliminar Outcomes

Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele

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