Surgical Management of Paralytic Scoliosis in Myelomeningocele

Parsch, Dominik; Geiger, Florian; Brocai, D. R. C.; Lang, Robert D.; Carstens, C.

doi:10.1097/00009957-200101000-00003

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…Several recent articles have addressed the need for single or staged anterior and posterior spine fusion in myelomeningocele. Parsch et al [2001] evaluated their experience in 54 patients with scoliosis secondary to myelomeningocele. They reviewed three different surgical techniques used in treating this difficult problem.…”

Section: Scoliosis In Spina Bifidamentioning

confidence: 99%

Orthopedic management of spina bifida

Thomson

Segal

2010

Dev Disabil Res Revs

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The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of knee pain. The importance of the hip abductor muscle and its influence on gait and knee function has been realized. Important developments in the treatment of spinal deformity include the use of pedicle screws which allow better correction. The role of anterior-only spinal surgery has been defined, which allows motion at the lumbo-sacral junction and has a lower postoperative infection rate than posterior surgery. Functional outcome assessments provide better feedback for surgeons and families in regards to which patients may benefit most from surgery. Overall, the past 10 years has seen the increased use of functional outcome measures such as Motion Analysis, oxygen consumption, and patient-based outcome assessments rather than traditional radiographic measures (e.g., hip dislocation or subluxation). This progress has resulted in a better understanding of spina bifida and, more importantly, improved outcomes for our patients. Additional research is likely to further enhance outcomes by establishing additional evidence-based interventions.

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Section: Scoliosis In Spina Bifidamentioning

confidence: 99%

Orthopedic management of spina bifida

Thomson

Segal

2010

Dev Disabil Res Revs

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“…Between 83% and 100% of patients with thoracic-level dysraphisms have been noted to develop scoliosis, whereas only 5% of sacral-level dysraphisms have been associated with scoliosis. 9,26,35,40 Furthermore, lumbar kyphosis has been reported to occur in 12%-28% of patients with myelomeningocele 4,14,39,40 and can contribute to significant functional impairment. Severe lumbar kyphosis is associated with the formation of a gibbus that contributes to epidermal ulceration and chronic nonhealing wounds, as well as functional impairment, decreased abdominal volume, respiratory compromise, back pain, and sitting imbalance.…”

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confidence: 99%

Kyphectomy in patients with myelomeningocele treated with pedicle screw–only constructs: case reports and review

Hwang¹,

Thomas²,

Blumberg³

et al. 2011

PED

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Object Significant lumbar kyphosis is frequently observed in patients with myelomeningocele and has been associated with increasing functional impairment, decreased abdominal volume, respiratory impairment, discomfort, and skin ulcerations overlying the prominent gibbus. Treatment of severe kyphotic deformities can include kyphectomy, with or without ligation of the thecal sac, with posterior spinal fixation. However, most series have reported a high rate of morbidity and complications associated with surgical intervention for correction of kyphosis in patients with myelomeningocele. The authors describe a technique in which pedicle screw (PS)–only constructs are used without transection of the thecal sac to treat severe kyphosis successfully, with minimal morbidity. Methods The authors retrospectively reviewed medical records and radiographic images in 2 patients with myelomeningoceles in whom kyphectomies had been performed at the authors' institution between January 2007 and July 2010. They also reviewed the existing literature for case reports or published series of patients with myelomeningocele treated with kyphectomies, to evaluate the outcomes. Results Both patients were male and had thoracic-level myelomeningoceles that had been repaired at birth, with associated paraplegia. Neither patient had any significant scoliotic deformity associated with the kyphosis, and both had fixation from T-9 to the ilium, which was performed using PS constructs, along with L1–2 kyphectomies. The patient in Case 1 was 20 years old and was treated for progressive kyphosis and an ulcerated nonhealing wound over the gibbus. The patient in Case 2 was 10 years old and was treated for progressive pain and functional impairment. The 2 patients had a mean correction of 63%, with a mean correction of kyphotic deformity from 136° to 51°. Neither patient developed any complication in the short term postoperatively, whereas published series have reported high complication rates, including wound infection, poor wound healing, CSF leakage, pseudarthrosis, and shunt malfunction. Conclusions Severe kyphotic deformities in patients with myelomeningocele can be safely treated using PS-only constructs without ligation of the thecal sac. Further evaluation with a larger sample and longer follow-up are needed to detect any associated complications, such as proximal junctional kyphosis. Further evaluation may also validate whether PS-only constructs permit successful outcomes with a shorter construct and fewer instrumented levels.

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“…The comparability was not adequately addressed in the majority of articles. Except for three studies [ 13 , 42 , 53 ], the exposure/outcome assessment was fully reported. Only two studies by Gerlach et al and Wang et al received a full score [ 46 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…These consequences affect patients’ appearance, ambulation, and quality of life by imposing consequences such as back pain and less social and personal acceptance [ 20 , 21 ]. Some of the surgical and non-surgical management include spinal fusion, spinal orthoses, and sitting supports [ 13 , 22 ]. These treatments may cause several complications, including decreased ambulation, pressure sores and other infections, implant problems, neurologic consequences, and interference with other care such as self-catheterization [ 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature

et al. 2021

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Background Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach. Methods We searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients. Results Twenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search. Conclusion Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. Graphical abstract

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Surgical Management of Paralytic Scoliosis in Myelomeningocele

Cited by 12 publications

References 19 publications

Orthopedic management of spina bifida

Orthopedic management of spina bifida

Kyphectomy in patients with myelomeningocele treated with pedicle screw–only constructs: case reports and review

Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature

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