Barros Alderico Girão Campos, Noronha Diogo R, Carelli Luis E, Skaggs David L
Department of Spine Surgery, National Institute of Orthopedics and Traumatology, INTO, Avenida Brasil 500 Caju, Rio de Janeiro, RJ, 20940-070, Brazil.
Department of Spine Surgery, National Institute of Orthopedics and Traumatology, INTO, Rio de Janeiro, Brazil.
Spine Deform. 2025 May;13(3):877-885. doi: 10.1007/s43390-024-01036-1. Epub 2025 Jan 11.
Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8 years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation.
Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation.
Case 1: Female; 4.5 years old at surgery; 5 year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5 mm. Case 2: Male; 7.4 Years old at surgery; 4 year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6 mm. Case 3: Female; 5.5 Years old at surgery; 27 month follow-up. No complications reported so far. Mean growth per year: 9.42 mm. None of the cases showed signs of sacral osteolysis or rod migration.
DISCUSSION / CONCLUSION: To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.
先天性腰椎后凸畸形存在于约15%的脊髓脊膜膨出患者中。畸形加重并伴有慢性皮肤溃疡和骨质暴露等并发症很常见。对于8岁以下的患者，治疗更具挑战性：除了切除后凸畸形的顶点外，理想情况下，我们应以不干扰胸廓生长的固定方法稳定脊柱，而这对于该人群的骨盆固定颇具挑战。生长友好型技术的出现使早发性畸形患者受益匪浅，能够在不干扰躯干生长的情况下矫正和控制偏差，而这些患者的躯干生长往往已经受到影响。我们描述了一种手术技术，并展示了一种新方法的初步临床结果，该方法将允许躯干生长的自滑动螺钉与用于远端固定的腰骶棒嵌压相结合。
该技术的适用对象为患有脊髓脊膜膨出和先天性腰椎后凸畸形、无法仰卧、有皮肤溃疡病史、复发性骨髓炎且体重增加不佳的患者。他们在脊髓脊膜膨出水平以下均缺乏感觉或运动功能。他们在椎体后凸切除术后均接受了相同的重建技术，该技术将允许躯干生长的自滑动螺钉与用于远端固定的腰骶棒嵌压相结合。
病例1：女性；手术时4.5岁；随访5年。1例并发症：1枚阻挡器松动。患儿情况良好，无需手术翻修。每年平均生长：9.5毫米。病例2：男性；手术时7.4岁；随访4年。1例并发症：术后感染，需要在手术室进行2次清创和延长抗生素治疗。每年平均生长：6毫米。病例3：女性；手术时5.5岁；随访27个月。目前未报告并发症。每年平均生长：9.42毫米。所有病例均未显示骶骨骨质溶解或棒移位的迹象。
讨论/结论：据我们所知，这是第一项将滑动螺钉与腰骶棒嵌压相结合的研究。尽管该技术已被证明安全有效，但我们意识到病例数量有限且随访时间较短。需要进一步研究以证实该方法。
