Twenty-nine patients (mean age 12 years) with severe thoracolumbar and lumbar scoliosis
due to myelomeningocele were treated by spinal fusion (7 by posterior arthrodesis
with instrumentation, 3 by anterior arthrodesis with instrumentation, 19 by combined
anterior and posterior fusion with instrumentation). Fusion was extended to the sacrum
in 15 patients. Mean period of follow-up was 6.2 years. The average Cobb angle changes
were as follows: thoracic and thoracolumbar curves preoperatively 86 degrees to 45
degrees at follow-up (the final average curve correction was 47 %); lumbar curves
preoperatively 97 degrees to 48 degrees at follow-up (the final average curve correction
was 50%). Average pelvis obliquity changed from 26 degrees to 13 degrees at follow-up
with an average correction of 49 %. The combined anterior and posterior instrumentation
and fusion gave the best correction of deformity (the final average thoracic and thoracolumbar
curve correction was 55%; the final average lumbar curve correction was 61%). Independent
of the method of stabilization, post-operative wound infection was a serious problem
(24%). The combined fusioninstrumentation method reduced the rate of pseudoarthrosis
to 14%.
Scoliosis in myelomeningocele - Spina bifida - Anterior and posterior combined arthrodesis
