Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation.

Kyphosis in the myelomeningocele patient population causes significant problems such as skin breakdown, recurrent infection, and decreased function. Kyphectomy has proved to be a satisfactory means of correcting the deformity, but postoperative stabilization to prevent recurrence of deformity continues to be a problem. Twelve patients with myelomeningocele kyphosis, measuring an average of 124 degrees, were managed by posterior kyphectomy and segmental spinal instrumentation. After operation, the curves measured an average of 32.8 degrees. With a follow-up period, 6-57 months, only one patient lost correction. The loss of correction was secondary to rod failure. Straight midline incision, ignoring previous incisions, can be used to approach the spine without risk of increased wound complications. Adequate immediate stable correction can be achieved by kyphectomy and segmental spinal instrumentation with anterior fixation to the pelvis that thus allows the patient to proceed more quickly to an improved functional level.