The surgical treatment of spinal deformity in children with non-ambulatory myelomeningocele

Aims To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. Methods We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire. Results The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar deformity. Mean scoliosis corrected from 89.6° (47° to 151°) to 46.5° (17° to 85°; p < 0.001). Mean kyphosis corrected from 79.5° (40° to 135°) to 49° (36° to 65°; p < 0.001). Mean pelvic obliquity corrected from 19.5° (8° to 46°) to 9.8° (0° to 20°; p < 0.001). Coronal and sagittal balance restored to normal. Complication rate was 58.3% (seven patients) with no neurological deficits, implant failure, or revision surgery. The degree of preoperative spinal deformity, especially kyphosis and lordosis, correlated with increased blood loss and prolonged hospital/intensive care unit stay. The patients reported improvement in function, physical appearance, and pain after surgery. The parents reported decrease in need for everyday care. Conclusion Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. This resulted in physical and functional improvement and high reported satisfaction. Cite this article: Bone Joint J 2021;103-B(6):1133–1141.

The Use of Porous Nickel Titanium Implants in Anterior Spinal Fusion of the Lumbar Spine

Back pain affects approximately 80% of the adult population. In the structure of the nervous system morbidity, cases of osteochondrosis account for up to 68%, reaching 72% of the days of temporary disability in the outpatient network and 48% in hospitals. Since 2004, surgical interventions using porous nickel titanium have been performed in the Department of Spinal Pathology in 43 patients with degenerative lesions of the lumbar spine. Of these, 23 were men and 20 women. At the age of 20 to 65 years (average age 46.1 years). In the postoperative period, a significant regression of pain intensity in the lumbar region and lower extremities was determined in 8 (18.6%) patients, and the complete disappearance of pain was determined in the remaining 35 (81.4%) patients. Before surgery, the Oswestry index averaged 48.3%, after surgery 13.4%.