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

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

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.

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.

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.