Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment.

We reviewed the cases of 16 patients with myelomeningocele and congenital kyphosis. Ten patients underwent kyphectomy with wire fixation and spinal fusion for severe-curve progression and problems with decubiti ulcers. The average curve magnitude at presentation for these 10 patients was 87 degrees (range 47-146 degrees); at an average follow-up of 5 + 8 years (range 2 + 9 to 9 + 9 years) after surgery, it was 60 degrees (range 15-80 degrees). A stable fusion was achieved in nine patients, and all 10 had improved status of their skin at their last follow-up. Six patients were managed by nonoperative means such as modified wheelchairs and orthoses. The average curve magnitude at the presentation for this group was 70 degrees (range 42 degrees - 93 degrees); at an average follow-up of 19 years (range 5 + 5 to 27 + 3 years), it was 106 degrees (range 65 degrees - 130 degrees). Two of these patients continue to have problems with skin breakdown. Kyphectomy enables patients to sit straighter and is the proper treatment for these patients. If operative treatment is prohibitive or denied for some reason, then suitable wheelchair modifications can enable these patients to function with reasonable comfort.