Short-term surgical complications of spinal fusion in myelomeningocele

Study design: Retrospective review of a prospective database.

Purpose: To determine the rate of short-term surgical complications in the 3-month postoperative period in patients with myelomeningocele (MMC) who underwent surgical correction of spine deformities.

Methods: This study reviewed the medical records of MMC patients, aged ≤ 18 years, who underwent spine deformity correction between 2012 and 2018. Clinical, radiological, and surgical variables were considered.

Results: Forty-six patients with primary preoperative curve, pelvic obliquity, and kyphosis mean values of 84.9º, 21.5º, and 76.1º, respectively, were included. Thirty-four (74%) patients underwent scoliosis correction and 12 (26%), kyphectomy. A trend in reduction of %EBV (estimated blood volume) loss with antifibrinolytic use from 50.2 ± 32.3 to 33.8 ± 17.2% was observed (p = 0.103). Simultaneous detethering was performed in 13 (27.7%) patients and was not associated with higher short-term complication rates. There were 12 cases of short-term surgical complications (26.1%); among them, six had deep wound infection requiring surgical debridement, and one a superficial wound infection. Drainage time longer than 4 days was significantly associated with wound infection (OR = 15.8, p = 0.01).

Conclusions: The surgical treatment of neuromuscular scoliosis in MMC patients is challenging because of the high comorbidity rate. Still, we found an admissible rate of short-term surgical complications with a multidisciplinary approach in a setting with extensive spine deformity surgery experience.