Severe spine deformity in myelodysplasia and sacral agenesis: an aggressive surgical approach.

The results of a prospective study of the surgical treatment of paralytic scoliosis and congenital lumbar kyphosis in 19 children with myelodysplasia and one child with sacral agenesis indicate that improved results can be achieved with the use of staged anterior and posterior fusions, more rigid spinal instrumentation, and bank and autogenous bone graft. No wound infections occurred as a result of preoperative treatment of urinary infection and with the use of prophylactic antibiotics. Improved posterior spinal fixation was accomplished with a double square end sacral hook in paralytic scoliosis and pelvic obliquity and with a cable-hook compression system in congenital lumbar kyphosis. Posterior lumbopelvic fusion with cable-hook compression instrumentation gave acceptable results in lumbopelvic kyphosis from complete sacral agenesis.