1/10. Apophyseolysis of the fourth lumbar vertebra: an early postoperative complication following kyphectomy in myelomeningocele.This is a report of a young girl with congenital kyphosis at the thoracolumbar spine in association with myelomeningocele. Kyphectomy and posterior stabilisation extending from the eighth thoracic to the fourth lumbar vertebra was done. Apophyseolysis occurred as an early postoperative complication at the level of the L4-L5 disc. This failure mode was treated by extending the fusion to the pelvis.- - - - - - - - - - ranking = 1keywords = myelomeningocele (Clic here for more details about this article) |
2/10. Evaluating congenital spine deformities for intraspinal anomalies with magnetic resonance imaging.SUMMARY: The incidence of intraspinal abnormalities associated with congenital spinal anomalies as detected by magnetic resonance imaging (MRI) is becoming better defined. In this study, 41 nonrandomized children with congenital spinal deformities (excluding myelomeningocele) who underwent complete MR evaluation were reviewed. Of the 41 congenital spinal deformities, 37 demonstrated congenital scoliosis, with failure of formation in 19, failure of segmentation in 4, and mixed defects in 14. The remaining four deformities were cases of congenital kyphosis. Thirteen patients with congenital spine anomalies were noted to have intraspinal abnormalities identified by MRI: tethered cord in 12 patients, syringomyelia in 3 patients, and diastematomyelia in 5 patients. Of the 12 patients with tethered cord, 2 patients had neurologic deficits. Urorectal anomaly was one of the most common associated findings (15%). Considering an incidence of intraspinal anomalies of 31% and as clinical manifestations may not be initially detectable, MRI is recommended in patients with congenital spinal deformity as part of the initial evaluation even in the absence of clinical findings.- - - - - - - - - - ranking = 0.2keywords = myelomeningocele (Clic here for more details about this article) |
3/10. Kyphectomy using a surgical threadwire (T-saw) for kyphotic deformity in a child with myelomeningocele.STUDY DESIGN: A 9-year-old boy with severe myelomeningocele kyphosis was treated by kyphectomy using a surgical threadwire. OBJECTIVE: To describe a new method of kyphectomy for severe kyphotic deformity in a child with myelomeningocele using a surgical threadwire. SUMMARY OF BACKGROUND DATA: Although several methods of kyphectomy for severe kyphotic deformity in children with myelomeningocele have been reported, few of these methods allow preservation of the nonfunctioning dural sac and cerebrospinal fluid flow, with the aim of reducing complications. methods: The preoperative kyphotic angle was 113 degrees. There was repeated skin ulceration over the apex of the kyphos. Kyphectomy at the Th12 to L3 vertebral levels was performed using a surgical threadwire (T-saw, developed by Tomita and colleagues in 1996), preserving the entire dural sac. RESULTS: The T-saw allowed anterior dissection of the dural sac over the length of the planned resection, thus preserving cerebrospinal fluid flow throughout the entire subarachnoid space. The kyphotic angle was decreased to 10 degrees after the operation, and the postoperative clinical course was uneventful. At the 2-year follow-up assessment, the kyphotic angle was 10 degrees according to plain radiograph. At this writing, the boy is able to maintain a sitting position without any difficulty. CONCLUSIONS: For this child with myelomeningocele, kyphectomy using a surgical threadwire (T-saw) provided a satisfactory result without any major complication.- - - - - - - - - - ranking = 1.6keywords = myelomeningocele (Clic here for more details about this article) |
4/10. Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.Closure of large meningomyelocele wounds and defects always requires durable and safe coverage of the dural repair. A new technical method for the reconstruction of large thoracolumbar meningomyelocele defects is described in which bilateral musculocutaneous flaps are advanced and transposed medially in a V-Y sliding manner, based on the thoracolumbar perforatiors of the latissimus dorsi. This procedure provides a reliable, well-vascularized soft tissue coverage over the neural repair with minimum donor-site morbidity. Additionally, this method is particularly appropriate to the thoracolumbar area, as it preserves the lateral adjacent regions of the defect, for later alternative and/or reconstructive options.- - - - - - - - - - ranking = 0.31696519949744keywords = meningomyelocele (Clic here for more details about this article) |
5/10. Anterior thoracic myelomeningocele presenting as a retromediastinal mass. Case report.Myelomeningocele presenting as a retromediastinal mass originating from the midline defect through the fused T-4, T-5, and T-6 VBs is described. An 11-year-old boy with a completely normal systemic and neurological examination suffering pulmonary problems such as effort dyspnea and severe kyphosis was evaluated and an anterior thoracic myelomeningocele was diagnosed. The boy underwent surgery for excision of the meningomyelocele sac and correction of kyphoscoliosis. His year-long follow-up period as an outpatient was uneventful. A comprehensive pubmed search of the literature returned no results for an "anterior thoracic myelomeningocele" query. To the best of the authors' knowledge, this is the only case described in the literature.- - - - - - - - - - ranking = 1.2528275332496keywords = myelomeningocele, meningomyelocele (Clic here for more details about this article) |
6/10. Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods.Myelomeningocele leads to kyphosis of the dysplastic spine in 12-20% of cases, resulting in a severe gibbus. In three patients (at the age of 9, 13 and 16 years) with a thoracolumbar kyphosis (90 degrees, 120 degrees and 95 degrees respectively), and a compensatory thoracic lordosis (35 degrees, 105 degrees and 90 degrees) a resection or a wedge osteotomy of the gibbus was performed with segmental sublaminar wire fixation to Luque rods. In addition, a spondylodesis with autogenous bone and an allograft was performed. Correction of the kyphosis (to 30 degrees, 60 degrees and 50 degrees) and lordosis (to 15 degrees, 65 degrees and 55 degrees) was attained. This posterior procedure was sufficient for correction; there was no need for an anterior release. Cord and dura were left intact. During follow-up (27, 60 and 30 months) no progression of the curves has been noted. This one-stage posterior correction with L-rod fixation proved to be a method of choice for this difficult-to-treat spinal deformity.- - - - - - - - - - ranking = 0.8keywords = myelomeningocele (Clic here for more details about this article) |
7/10. The management of kyphosis in patients with myelomeningocele.kyphosis in myelomeningocele is a progressive condition, which can lead to severe deterioration of function and skin ulceration over the apex of the kyphus. Since bracing is impractical, surgical correction and stabilization is the recommended method of management. Three different techniques are in current use. An anterior procedure using a plate and u-bolt shackles, an anterior approach using a bone strut, and a posterior approach excising a wedge, and the spinal cord if it is functionless. We recommend the wedge excision combined with posterior Harrington compression instrumentation and spinal fusion extending well above and below the resection. Regardless of the approach used, it is the long spinal fusion both anterior and posterior, which will maintain correction.- - - - - - - - - - ranking = 1keywords = myelomeningocele (Clic here for more details about this article) |
8/10. Luque rod fixation in meningomyelocele kyphosis: a preliminary report.A preliminary report is given of four cases of kyphosis in the thoracolumbar and lumbar regions in paraplegic meningomyelocele patients treated by means of segmental spinal (Luque) rod fixation. The system, incorporating fixation at multiple levels and the principle of the three-point pressure system, appears highly effective in obtaining and maintaining correction in a deformity which has previously proven refractory in a high proportion of cases.- - - - - - - - - - ranking = 0.26413766624787keywords = meningomyelocele (Clic here for more details about this article) |
9/10. Congenital kyphosis in myelomeningocele. Vertebral body resection and posterior spine fusion.The deforming mechanisms in the congenital lumbar kyphosis of myelomeningocele are situated anteriorly. Posterior wedge resection with local fusion therefore will not prevent progression of the deformity. Nonetheless, this procedure may be the only method of affording sac closure, or providing continuity of the ulcerated integument. Definitive corrective surgery will be required later and must combat the anterior deforming forces. Resection of the apical vertebral body followed by posterior fusion with Harrington instrumentation provides a solid straight spine.- - - - - - - - - - ranking = 1keywords = myelomeningocele (Clic here for more details about this article) |
10/10. hypoglossal nerve injury caused by halo-suspension traction. A case report.STUDY DESIGN: A case report of injury to the hypoglossal nerve (CN XII) resulting from the use of halogravity traction in a child with severe cervicothoracic kyphosis after an anterior and posterior spinal release. OBJECTIVE: To describe one of the potential dangers of halo-suspension (gravity) traction, which has not been reported previously in the orthopedic literature. SUMMARY OF BACKGROUND DATA: cranial nerve injuries resulting from halo-skeletal traction are a recognized complication of such treatment, especially in patients with myelomeningocele. Halo-suspension traction using the patient's body weight as counter-traction has been recommended to provide a less rigid force and to reduce complications. methods: The authors report on the mechanism of injury and clinical course in a 12-year-old boy with myelomeningocele and a bilateral CN XII injury caused by halo-suspension traction from onset to resolution. RESULTS: This patient had dysphagia and difficulty swallowing 5 days after surgery. His wheelchair traction at this point was approximately 40% of his body weight. The traction was reduced, and a corticosteroid was administered. The patient's symptoms began to abate 5 days later. At 6 weeks after injury, his cranial nerve function was normal. CONCLUSIONS: Although halo-suspension traction or halo-wheelchair traction may be less rigid, injury to the hypoglossal nerve can be produced with traction exceeding 40% of body weight. In the patient in the current report, resolution of this injury was complete within 5 weeks, an outcome that is consistent with those of other reported cases of CN XII injury.- - - - - - - - - - ranking = 0.4keywords = myelomeningocele (Clic here for more details about this article) |
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