Surgical management of kyphosis in meningomyelocele

Spinal deformities, particularly scoliosis and kyphosis, are frequently encountered in patients with myelomeningocele. Rigid lumbar and thoracolumbar kyphosis presents serious functional impediments with regard to sitting balance, and the use of upper extremities other than for balance can lead to chronic skin breakdown over the gibbus deformity. Many patients are unable to lie supine because of the severe deformity, and bracing has not been shown to change the natural history of the kyphosis. Surgery is the only proven method to improve the sagittal spine alignment leading to improvements in posture, sitting balance, as well as ability of the caretaker to provide care for the patient. Several types of kyphectomies have been shown to have excellent results with regard to the sagittal plane correction. Vertebral column resections with multiple different options for instrumentation have been studied extensively. Decancellation vertebrectomies, also known as pedicle subtraction osteotomies or eggshell procedures, have also been demonstrated to achieve adequate kyphosis correction and are a viable option as well. Although these procedures are effective in achieving preoperative goals, it must be noted that there is a high incidence of perioperative complications that the surgeon and family must also be aware of. This chapter will discuss the background of the deformity, the perioperative issues revolving around the treatment, the surgical details including different strategies, a result reviews from the past, as well as the most common complications seen during kyphectomy in myelomeningocele patients.