SURGICAL TREATMENT OF SEVERE COMBINED KYPHOSIS SECONDARY TO MYELOCELE: FIRST HOMELAND EXPERIENCE

Abstract

Objective. To analyze the outcomes of surgical treatment of severe combined kyphosis secondary to myelocele.

Material and Methods. Retrospective analysis of outcomes in six patients operated on for severe combined kyphosis secondary to myelocele was performed. Correction and posterior instrumented bicortical fixation (PIBF) with expandable systems (VEPTR, TSRH) by type of dynamic bracing were used in patients with mobile kyphosis less than 30°. Correcting vertebrotomy at the curve apex with PIBF was performed for rigid kyphosis greater than 30°. Patients with severe kyphosis and bed sores in the area of the curve apex underwent halo-pelvic external fixation for extrafocal deformity correction, stabilization and creating conditions for soft tissue healing before corrective vertebrotomy at the apex of kyphosis and PIBF.

Results. The average correction was 71 %. In all children support function of the spine was restored, and functional class and physical status improved.

Conclusion. The choice of technique in patients with spinal hernia sequelae and progressive kyphosis should be differentiated depending on the size and rigidity of kyphosis and trophic complications. Degree of correction should be sufficient to consider deformity as compensated one. This assumes corrected contour of the spine, restored its support ability, increased volume of the deformed thorax, and improved respiratory function. Hir. Pozvonoc. 2014; (1):65-70.