Surgical treatment of scoliosis associated with myelomeningocele

Twenty-nine patients (mean age 12 years) with severe thoracolumbar and lumb ar scoliosis due to myelomeningocele were treated by spinal fusion (7 by po sterior arthrodesis with instrumentation, 3 by anterior arthrodesis with in strumentation, 19 by combined anterior and posterior fusion with instrument ation). Fusion was extended to the sacrum in 15 patients. Mean period of fo llowup was 6.2 years. The average Cobb angle changes were as follows: thora cic and thoracolumbar curves preoperatively 86 degrees to 45 degrees at fol low-up (the final average curve correction was 47 %); lumbar curves preoper atively 97 degrees to 48 degrees at followup (the final average curve corre ction was 50 %). Average pelvis obliquity changed from 26 degrees to 13 deg rees at follow-up with an average correction of 49 %. The combined anterior and posterior instrumentation and fusion gave the best correction of defor mity (the final average thoracic and thoracolumbar curve correction was 55 %; the final average lumbar curve correction was 61 %). Independent of the method of stabilization, post-operative wound infection was a serious probl em (24%). The combined fusion-instrumentation method reduced the rate of ps eudoarthrosis to 14%.