Bilateral rib-to-pelvis growth-friendly spinal surgery for congenital kyphosis in the child with myelomeningocele delays but does not prevent a definitive procedure.

Autor: Karlin LI; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. lawrence.karlin@childrens.harvard.edu., Fitzgerald RE; Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA., Smith JT; Primary Children's Hospital, Salt Lake City, UT, 84113, USA.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Dec 06. Date of Electronic Publication: 2024 Dec 06.
DOI: 10.1007/s43390-024-01017-4
Abstrakt: Purpose: To determine the efficacy of bilateral rib-to-pelvis distraction instrumentation for the growth-friendly surgical treatment of congenital kyphosis in children with myelomeningocele.
Methods: The clinical courses of nine children (five males, four females), mean age 4.3 years (range 1.4 years-10.0 years), with myelomeningocele and congenital kyphosis treated by the rib-to-pelvis surgical method were studied. Radiographic measurements established the extent of deformity corrections, spinal elongation and growth, and rib levels. Surgical complications were categorized as wound or instrumentation related.
Results: The mean follow-up was 5.2 years (range, 2.4 years-10.4 years). Following the index procedure, a mean of seven procedures (range, 4-20), or 1.2 procedures per year, were performed on each child. The mean preoperative, postoperative, and final follow-up kyphotic deformity was 139° (range, 93°-180°), 86°(range, 45°-150°) and 98° (range, 50°-176°) respectively. Eight children lost some of the initial correction and the two youngest lost all correction. Six children were converted to spine-based procedures. The mean growth for the cohort was 0.6 cm/year (range, -1.2 cm-1.9 cm). Twenty-two complications occurred in eight children-14 in the three youngest children. In two children the procedure was abandoned due to ulceration over the gibbus after 2.8 years and 5.6 years of treatment.
Conclusion: The bilateral rib-to-pelvis surgical procedure produced modest deformity correction and spinal growth, and prevented deformity progression. It delayed but did not eliminate the need for spine-based deformity correction, and was associated with the significant morbidity of distraction-based growth-friendly spinal surgery. The rib-based technique may have a role in a child with myelomeningocele kyphosis when surgical intervention is required in the very young.
Competing Interests: Declarations. Conflict of interest: Dr. Karlin has no relevant financial or non-financial interests to disclose. Dr. Fitzgerald did not receive funding for the conduction of this study; is a consultant for DePuy Synthes Spine, Medtronic, and OrthoPediatrics. Dr. Smith did not receive funding for conduction of this study; has received royalties from Globus Medical; has received consulting fees from Wishbone and Zimvie; participates on a Data Safety Monitoring Board or Advisory Board from the Pediatric Spine Study Group; and is a board member of the Pediatric Spine Foundation. The Pediatric Spine Study Group is supported by the Pediatric Spine Foundation; has received research funding from DePuy Synthes Spine, Globus, OrthoPediatrics, ZimVie; and has received educational support from Atec, Zim Vie, DePuy Synthes, OrthoPediatrics, Medtronic, Globus, nView Medical, Stryker, Boston Orthotics, and Pacira.
(© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)
Databáze: MEDLINE
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