Bilateral rib-to-pelvis growth-friendly spinal surgery for congenital kyphosis in the child with myelomeningocele delays but does not prevent a definitive procedure

Purpose: To determine the efficacy of bilateral rib-to-pelvis distraction instrumentation for the growth-friendly surgical treatment of congenital kyphosis in children with myelomeningocele.

Methods: The clinical courses of nine children (five males, four females), mean age 4.3 years (range 1.4 years-10.0 years), with myelomeningocele and congenital kyphosis treated by the rib-to-pelvis surgical method were studied. Radiographic measurements established the extent of deformity corrections, spinal elongation and growth, and rib levels. Surgical complications were categorized as wound or instrumentation related.

Results: The mean follow-up was 5.2 years (range, 2.4 years-10.4 years). Following the index procedure, a mean of seven procedures (range, 4-20), or 1.2 procedures per year, were performed on each child. The mean preoperative, postoperative, and final follow-up kyphotic deformity was 139° (range, 93°-180°), 86°(range, 45°-150°) and 98° (range, 50°-176°) respectively. Eight children lost some of the initial correction and the two youngest lost all correction. Six children were converted to spine-based procedures. The mean growth for the cohort was 0.6 cm/year (range, -1.2 cm-1.9 cm). Twenty-two complications occurred in eight children-14 in the three youngest children. In two children the procedure was abandoned due to ulceration over the gibbus after 2.8 years and 5.6 years of treatment.

Conclusion: The bilateral rib-to-pelvis surgical procedure produced modest deformity correction and spinal growth, and prevented deformity progression. It delayed but did not eliminate the need for spine-based deformity correction, and was associated with the significant morbidity of distraction-based growth-friendly spinal surgery. The rib-based technique may have a role in a child with myelomeningocele kyphosis when surgical intervention is required in the very young.