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The article discusses the surgical treatment of neuromuscular scoliosis associated with myelomeningocele. The traditional approach involves a posterior spinal fusion, but this has a high complication rate, particularly with deep infections. The study evaluates the outcomes and complications of using an isolated anterior thoracolumbar fusion as an alternative. The retrospective analysis included 16 patients who underwent this procedure, with an average follow-up of 5.5 years. No deep wound infections were reported from the anterior surgery, but 56% of patients required posterior revision surgery due to adding-on or junctional deformity. Two of these patients developed deep wound infections following distal extension. The study concludes that while anterior fusion reduces the risk of deep infection, many patients still require posterior revision surgery. However, overall, this approach can help in mitigating the risk of complications associated with the posterior approach
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best rated treatment clinic in London
Published article
CONCLUSIONS: Patients undergoing isolated anterior fusion for scoliosis associated with myelomeningocele have low infection rates but often require posterior revision. The majority of patients can avoid the deep infection risk associated with distal posterior surgery at long-term follow-up.
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Spine Deform. 2023 Aug 25. doi: 10.1007/s43390-023-00747-1. Online ahead of print.ABSTRACTPURPOSE: Neuromuscular scoliosis associated with myelomeningocele is a difficult clinical dilemma for the treating surgeon. The traditional surgical treatment consists of a posterior spinal instrumented fusion with or without a combined anterior procedure, but this has been associated with high complication rates, mostly related to,
Spine Deform. 2023 Aug 25. doi: 10.1007/s43390-023-00747-1. Online ahead of print.
ABSTRACT
PURPOSE: Neuromuscular scoliosis associated with myelomeningocele is a difficult clinical dilemma for the treating surgeon. The traditional surgical treatment consists of a posterior spinal instrumented fusion with or without a combined anterior procedure, but this has been associated with high complication rates, mostly related to deep infection. An anterior thoracolumbar fusion is not able to address the entirety of the deformity in many cases but could potentially avoid the devastating infection risks from the posterior approach by avoiding compromised skin. This study aims to evaluate the long-term outcomes and complications associated with isolated anterior thoracolumbar fusion in this high-risk group.
METHODS: This study is a retrospective analysis of patients with myelomeningocele-associated scoliosis treated with an isolated anterior spinal fusion over a 20-year time period at a single center. Surgical details, demographics, curve characteristics and complications were recorded. Comparisons were made between patients who required revision surgery and those who did not.
RESULTS: Sixteen patients were enrolled with an average age of 12.7 years at the time of surgery and average follow-up of 5.5 years. Patients had on average 7.4 levels fused anteriorly with the most common levels being T10-L4. There were no deep wound infections associated with the anterior surgery. Overall, nine patients (56%) had to be revised posteriorly due to adding-on or junctional deformity at an average of 3.7 years after index procedure. Four patients were revised due to proximal adding-on, while 1 was extended distally. Four additional patients were extended both proximally and distally. Of the posterior revisions, 2 patients developed deep wound infections, and both of these were in patients extended distally. Preoperative lumbar lordosis was higher in patients who required distal extension (100 vs. 69 degrees; p = 0.035).
CONCLUSIONS: Patients undergoing isolated anterior fusion for scoliosis associated with myelomeningocele have low infection rates but often require posterior revision. The majority of patients can avoid the deep infection risk associated with distal posterior surgery at long-term follow-up.
LEVEL OF EVIDENCE: IV.
PMID:37624554 | DOI:10.1007/s43390-023-00747-1
The London Spine Unit : best rated treatment clinic in London
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Long-term outcomes and complications of isolated anterior thoracolumbar fusion for neuromuscular scoliosis associated with myelomeningocele
