The long-term results of kyphectomy and spinal stabilization in children with myelomeningocele.

Ten myelomeningocele patients with a severe lumbar kyphosis were treated by resection of their kyphus, internal fixation, and spinal fusion. A mean kyphosis of 131 degrees was reduced to 44 degrees following the surgery. This was a very major procedure, associated with many complications. One patient died during the surgery and the remaining nine patients were followed for a mean of 7 years 4 months to skeletal maturity. The most successful methods of internal fixation were either by two Harrington distraction rods combined with compression across the osteotomy site (Group 3) or by a posteriorly applied AO plate (Group 2). A long posterior fusion extending from the mid-thoracic region to the sacrum was necessary to provide long-term stability and prevent the development of a thoracic lordosis. At skeletal maturity, all seven patients in Groups 2 and 3 had a flat back without pressure sores and all were able to sit upright without using their arms for support.