Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK.
Bone Joint J. 2021 Jun;103-B(6):1133-1141. doi: 10.1302/0301-620X.103B6.BJJ-2020-2158.R1.
To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.
We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire.
The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar deformity. Mean scoliosis corrected from 89.6° (47° to 151°) to 46.5° (17° to 85°; p < 0.001). Mean kyphosis corrected from 79.5° (40° to 135°) to 49° (36° to 65°; p < 0.001). Mean pelvic obliquity corrected from 19.5° (8° to 46°) to 9.8° (0° to 20°; p < 0.001). Coronal and sagittal balance restored to normal. Complication rate was 58.3% (seven patients) with no neurological deficits, implant failure, or revision surgery. The degree of preoperative spinal deformity, especially kyphosis and lordosis, correlated with increased blood loss and prolonged hospital/intensive care unit stay. The patients reported improvement in function, physical appearance, and pain after surgery. The parents reported decrease in need for everyday care.
Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. This resulted in physical and functional improvement and high reported satisfaction. Cite this article: 2021;103-B(6):1133-1141.
报告 12 例接受前路脊柱融合术的脊髓脊膜膨出致四肢瘫患者脊柱畸形矫正的结果。
我们回顾了 12 例连续患者（7 例男性，5 例女性；平均年龄 12.4 岁[9.2 至 16.8]）的人口统计学细节、脊柱骨盆参数、手术矫正和围手术期数据。我们使用脊柱裂脊柱问卷和定性问卷评估手术对患者结局的影响。
平均随访时间为 5.4 年（2 至 14.9 年）。9 例患者有脊柱后凸侧凸，2 例患者有脊柱前凸侧凸，1 例患者有脊柱后凸。所有患者均有胸腰椎畸形。平均脊柱侧凸从 89.6°（47°至 151°）矫正至 46.5°（17°至 85°；p<0.001）。平均后凸从 79.5°（40°至 135°）矫正至 49°（36°至 65°；p<0.001）。平均骨盆倾斜从 19.5°（8°至 46°）矫正至 9.8°（0°至 20°；p<0.001）。冠状面和矢状面平衡恢复正常。并发症发生率为 58.3%（7 例），无神经功能缺损、植入物失败或翻修手术。术前脊柱畸形程度，特别是后凸和前凸，与术中出血量增加和住院/重症监护病房住院时间延长相关。患者报告术后功能、身体外观和疼痛改善。家长报告日常护理需求减少。
前路脊柱融合术可实现满意的畸形矫正，但在高节段脊髓脊膜膨出儿童中，围手术期并发症发生率高，但无长期后遗症。这导致了身体和功能的改善，并获得了很高的满意度。 引用本文：2021；103-B（6）：1133-1141。
