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Purpose <p>This study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes.</p> Methods <p>A retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into “early vs. late” groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and Cochran-Armitage trend tests.</p> Results <p>The cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63%) experienced major complications (MCDS ≥ III), predominantly wound-related (79). The late group was older at index surgery (6.7 vs. 7.7&#xa0;years, p = 0.031) and had a higher rate of index fusion (7.5% vs. 20.2%, p = 0.022). Preoperative and postoperative radiographic parameters were similar. Among GF patients, 71 underwent definitive spinal fusion. On average, patients treated with VEPTR/TGR underwent 5 lengthening procedures, while those treated with MCGR underwent 8. Across all GF patients, the average number of unexpected reoperations was 1.6. Overall five-year complication rates did not differ significantly between early and late cohorts (66.7% vs. 60.6%; p &gt; 0.05). A declining trend in complication rates over time was observed (p = 0.082).</p> Conclusions <p>From 2002–2019, surgical management of MMC evolved toward increased index fusion and older age at index, possibly to reduce repeat surgery risks. Despite this, radiographic outcomes and overall complication rates were similar between early- and late-era cohorts, and a downward trend in complications that approached statistical significance was observed over time.</p> <p>Level of Evidence.</p> <p>IV.</p>

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Evolving surgical strategies in myelomeningocele (MMC): shift toward index fusion with stable complication rates

  • 期刊论文

  • 发表日期：

    2026年4月4日

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  • Edwin S. Kulubya,
  • Matthew J. Weintraub,
  • Omar Taha,
  • Mehdi M. Elfilali,
  • Chidebelum O. Nnake,
  • Alexander M. Park,
  • Michael W. Brown,
  • Taemin Oh,
  • John T. Smith,
  • Paul D. Sponseller,
  • Purnendu Gupta,
  • Lawrence I. Karlin,
  • Michael G. Vitale,
  • Benjamin D. Roye

摘要

Purpose

This study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes.

Methods

A retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into “early vs. late” groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and Cochran-Armitage trend tests.

Results

The cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63%) experienced major complications (MCDS ≥ III), predominantly wound-related (79). The late group was older at index surgery (6.7 vs. 7.7 years, p = 0.031) and had a higher rate of index fusion (7.5% vs. 20.2%, p = 0.022). Preoperative and postoperative radiographic parameters were similar. Among GF patients, 71 underwent definitive spinal fusion. On average, patients treated with VEPTR/TGR underwent 5 lengthening procedures, while those treated with MCGR underwent 8. Across all GF patients, the average number of unexpected reoperations was 1.6. Overall five-year complication rates did not differ significantly between early and late cohorts (66.7% vs. 60.6%; p > 0.05). A declining trend in complication rates over time was observed (p = 0.082).

Conclusions

From 2002–2019, surgical management of MMC evolved toward increased index fusion and older age at index, possibly to reduce repeat surgery risks. Despite this, radiographic outcomes and overall complication rates were similar between early- and late-era cohorts, and a downward trend in complications that approached statistical significance was observed over time.

Level of Evidence.

IV.