Treatment of spinal deformity in myelomeningocele: a retrospective study in four hospitals.

Correction of spinal deformities in patients with myelomeningoceles (mmc) is notoriously complicated. To identify the deformity, frequency, gravity and complications of treatment a retrospective study was carried out on 61 patients from four hospitals. 45 patients had neurological defect above L3 and were wheelchair-bound. The indications for surgery were progressive disturbance in sitting balance, pain and pressure sores. Two types of spinal deformity were identified; scoliosis (often thoraco-lumbar or double major curves) and kyphosis (usually angular and lumbar). The mean age at operation was 12 years 8 months (2y 6m-19y 7m). Several operative procedures were used; posterior, anterior and circumferential fusion, and resection of the kyphosis. 52 solid fusions were achieved with variable correction at the cost of many complications such as excessive blood loss (2), post-operative pressure sores (15), failure of instrumentation (15), deep infection (11), and death following a CSF leak (1). 4 patients died from unrelated causes. Only 16 patients had no complications. The type and severity of scoliosis and kyphosis, operative technique, results and complications were correlated to identify the risks and define the optimal surgical technique for each type of spinal deformity in mmc.