CORR Insights®: Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele?

Kyphosis in patients with myelomeningocele can cause skin ulceration, pain, and substantial sitting imbalance. Bracing may stabilize the deformity or delay surgical intervention until skeletal maturity, but it is not always effective. Surgical indications include breakdown of the soft-tissue envelope overlying the gibbus, sagittal imbalance, and progressive deformity. This condition is difficult to treat surgically because complications, such as loss of correction, loss of fixation, revision surgery, and even death after surgery are disconcertingly common [1-3, 5, 6, 8-11]. Wound healing and infection are common reasons for reoperation in this population and are likely a result of operating through the tenuous soft-tissue scar of patients with myelomeningocele. By avoiding incisions through the soft-tissue scar, Hyndman’s Halifax kyphectomy and Torode’s technique may decrease the risk of wound-healing problems [3, 12], but they do not eliminate it. Loss of fixation may be caused by anatomic deficiency of the posterior elements and poor bone quality, though pedicle screw fixation has demonstrated some promise in mitigating these issues [1, 5]. In the current study, Petersen and colleagues [9] evaluated the risk of complications and reoperation as well as the impact of surgery on healthrelated quality of life (HRQoL) in children with myelomeningocele undergoing surgical correction of their lumbar kyphosis. Their technique involves posterior fixation using "Sshaped" rods inserted through the foramina of S1 and pedicle screws in the thoracic spine. The authors found that complications (including infection requiring débridement and wound breakdown requiring plastic surgery with advancement flap for coverage) were common and 68% of the patients underwent reoperation [9]. Their study supports several others that have documented a high risk of complications and reoperations in this patient population [2, 8, 10]. The results in the current study are important because the authors evaluated HRQoL in patients treated with kypectomy [9]. While previous studies have focused on surgical outcomes alone, the current study focuses on outcomes from the patient’s perspective. Because they reported improvement in HRQoL, despite a high complication rate, their findings allow clinicians to more confidently counsel patients about the potential impacts of the surgery [9]. Patients will expect that there may be future unplanned reoperations but that their quality of life should still be improved.