Abstract:

Introduction: Surgical correction of spinal deformity in myelomeningocele is associated with high rates of pseudarthrosis and implant failure. The anterior fusion is traditionally a wide exposure from the thorax to the sacrum. We report minimally invasive lateral interbody fusion (MILIF) to address the issue of fusion between vertebrae with marginal posterior elements while minimizing the morbidity of an open approach. Materials and Methods: We performed a single-center, retrospective review of patients with myelomeningocele and severe scoliosis who underwent posterior spinal fusion (PSF) and staged MILIF for anterior fusion of the thoracolumbar/lumbar spine. We identified four patients with high risk of curve progression who met the following inclusion criteria: diagnosis of myelomeningocele, severe scoliosis (Cobb angle > 70°), PSF using greater than 80% pedicle screws, age greater than 10 years at time of surgery, and a minimum follow-up of two years. Radiographic, clinical, and complication data were reviewed. Results: All four patients achieved fusion (100%). The average age at index surgery was 12.8 years (range, 11–16) and follow-up was 3.2 years (range, 2–4.9). The average preoperative coronal Cobb angle measured 111° (range, 74–140°). The average postoperative Cobb angle at follow-up measured 37° (range, 23–42°). The MILIF procedure was performed an average of six months after the index procedure. After anterior fusion, all patients spent one day in the pediatric ICU and an average of 5.5 days in the hospital (range, 4–7). One patient (25%) developed a postoperative wound infection after PSF which required irrigation and debridement in the operating room. Conclusion: MILIF as an adjunct to posterior spinal fusion for severe scoliosis associated with myelomeningocele may provide acceptable fusion rates, curve correction, maintenance of correction at mid-term follow-up, and be associated with less morbidity than the traditional anterior approach.

Authors:

Justin A. Iorio, MD, Resident, Orthopedic Surgery, Temple University Hospital, Philadelphia, PA, Andre M. Jakoi, MD, Resident, Orthopedic Surgery, University Orthopedic Institute at Hahnemann, Philadelphia, PA, Craig D. Steiner, MD, Resident, Orthopedic Surgery, Temple University Hospital, Philadelphia, PA, Patrick J. Cahill, MD, Attending Physician, Orthopedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, Amer Samdani, MD, Chief of Surgery, Neurological Surgery, Shriners Hospital for Children, Philadelphia, PA, Randal R. Betz, MD, Attending Physician, Orthopedic Surgery, Institute for Spine & Scoliosis, Lawrenceville, NH, Anuj Singla, MD, Attending Physician, Orthopedic Surgery, University of Virginia, Charlottesville, VA

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