Surgical treatment of scoliosis in patients with myelomeningocele

Author(s): POTACZEK TOMASZ, TĘSIOROWSKI MACIEJ, ZARZYCKI DANIEL, JASIEWICZ BARBARA

Introduction: aetiology of scoliosis in patients with myelomeningocele may be congenital or noncongenital. Treatment o choice in these patients is surgery. Aim of paper: evaluate the results of surgical treatment and establish treatment guidelines in these patients. Material: 35 patients treated between 2000 and 2006. Methods: study group divided in 2 subgroups: without congenital anomalies (group A;n=23) and with anomalies causing scoliosis (group B;n=12). We evaluated: curve type, cord tethering, level of posterior elements absence, curve magnitude, coronal balance, pelvis inclination pre- and postsurgery. Surgery consisted of anterior fusion with instrumentation, followed by posterior fusion when required. Results: curves were shorter in gr.A (mean nr of vertebrae 8,3 vs 7,7), curve apex was usually Th12(31%) gr.A, and Th11(28%) gr.B. Most common level of posterior wall absence was Th11 (gr.A) and Th10 (gr.B). Cord tethering was present in 23% of patients in gr.A, and 41% in gr.B. Mean curve angle before surgery was 96,7° (gr.A) and 84,8° (gr.B). Mean pelvis inclination was 23° (gr.A) and 17,3° (gr.B). Age at surgery was higher in gr.A (11,8 years vs. 9,3 years). Final curve correction was 31,2% (gr.A) vs. 24,6% (gr.B). Only 4 patients required posterior fusion in gr.B vs. 14 (61%) in gr.A. At follow-up examination mean curve magnitude was 68,1°; pelvis inclination 16,5° (gr.A) vs. 69,2° and 11,3° (gr.B). Conclusion: in patients with myelomeningocele and congenital scoliosis anterior fusion may be the treatment of choice, presence of stable deformations prevents curve progression, in cases of noncongenital deformities wide anterior fusion followed by posterior fusion is recommended.