Kyphectomy in Myelomeningocele for Severe Early-Onset Kyphosis Using Distal Intravertebral Fixation and Thoracic Growing Rods. (September 2019)

• Record Type: Journal Article
• Authors: Alshaalan, Khalid Saud; Howard, Jason J.; Alshangiti, Ahmed Khaled; Alkhalife, Yasser I.; Aleissa, Sami; Al Sayegh, Samir Omar
• Is Part Of: Journal of the AAOS. Volume 3:Number 9(2019)
• Publication Date: 2019-09
• Subjects: Orthopedic surgery -- Periodicals; 617.4705
• DOI: 10.5435/JAAOSGlobal-D-19-00006
• Languages: English
• ISSNs: 2474-7661

Abstract

Abstract : Background: Most kyphectomy techniques require distal dissection of the bifid posterior spinal elements for implants placement in the thoracolumbar/pelvic regions, traversing the scarred tissue associated with previous MMC closure, thereby theoretically increasing the risk of wound complications. The Halifax kyphectomy technique avoids the MMC scar but does not reliably facilitate thoracic growth for early-onset kyphosis. This study aims to report the technique and outcomes of a combined Halifax kyphectomy (resection of the apical vertebrae with distal anterior multilevel vertebral body fixation) and thoracic growing rod construct used to treat early-onset symptomatic gibbus in a patient with myelomeningocele (MMC). Methods: A 3-year-old girl with a thoracic MMC presented with symptomatic gibbus requiring surgical intervention. Correction by the Halifax kyphectomy technique combined with spine-based growing rods was performed. Results: After the correction, the skin was closed primarily without the need for any flap for coverage. No wound complications or infection occurred post-operatively. The intraoperative blood loss was 200 mL, and the surgical time was 419 minutes. No pulmonary complications occurred postoperatively. At the final follow-up at 3 years 11 months postoperatively, the child had no recurrence of the deformity. Conclusions: The combination of distal anterior multilevel vertebral body fixation with spine-based thoracic growing rods can successfully achieve kyphosis correction in MMC, with the potential to reduce complication rates and facilitate thoracic growth. Further investigation is necessary to prove whether the outcomes and the complication rates are superior to other established techniques.