ABSTRACT

The term myelomeningocele is used to define a neural tube defect affecting the spine and spinal cord. It is commonly found with spinal deformations, such as kyphosis and lordosis (62%), as well as other neurological problems. Scoliosis is seen at a rate of 50–90%, and kyphosis in the lumbar region is seen at a rate of 8–20% with myelomeningocele. Most of the curvature is rigid, often greater than 80° at birth, and it is generally progressive, progressing 6–12° per year. Surgery for the deformation carries high complication risks. The aim of this study is to evaluate the inclusion of the skin slipping process in the same session as posterior lumbar vertebral resection osteotomy without damaging the neural structures, in a myelomeningocele patient with kyphosis.

Stabilization together with posterior vertebral resection osteotomy was administered to a 6-yearold male patient with myelomeningocele (myelodysplasia or spina bifida) deformation with rigid kyphosis and skin problems, with rigid lumbar kyphosis deformation and scoliosis accompanying the posterior vertebral elements. Stabilization was performed using thoracic-lumbar-pelvic pedicle screw fixation (T9–sacroiliac), resection osteotomy from the L3 vertebral disc levels, and skin slipping with plastic surgery for sufficient scar closing in the same session. A postoperative brace was administered for six months.

While the preoperative lumbar kyphosis angle was 82° (T12–S1), 26° of lumbar lordosis was obtained postoperatively. While the preoperative scoliosis angle was 21° (T8–L4), this reduced to 6°. The clinical and radiological results in the early postoperative period and after a six month follow-up were found to be very satisfactory. There were no complications in the early postoperative follow-up. The patient was able to sit without support.

In spinal deformations seen with myelomeningocele, especially for rigid kyphotic deformations, a satisfactory result can be obtained in the early period with scar protective treatment and simultaneous deformation correction, for appropriate cases using recent approach methods. With this treatment, we obtained a better lordosis angle by protecting the neural tissues, a balanced and straight seat in the sagittal plane, and good skin closure in the surgical area.