Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele

Kyphosis in myelomeningocele is characterized by a complex pattern of probl ems during development and therapy. On the one hand, decompensation of upri ght posture leads to loss of sitting ability and social integration; on the other hand, accompanying malformations and trophic alterations threaten th e physical integrity and performance. Neurologic function, cerebrospinal fl uid (CSF) circulation, skeletal deformity and the urinary transport system need to be kept in mind and need to be treated with cooperation between the different specialties. Especially during serious surgical interventions su ch as spinal surgery, neither the nervous system nor the kidneys must be ig nored. Sixteen patients underwent kyphectomy in the Orthopedic Department o f the University of Mainz between 1993 and 1997, all of them supervised by the Neurosurgical Department. In 13 cases, transversal myelotomy was perfor med. No insufficiency of CSF circulation was seen; neither were there any C SF fistulae. Particular problems arose from the skin and soft tissue above the gibbus, the lack of muscles and the regeneration deficiency caused by t rophic disorders. Therefore, a significantly higher complication rate was f ound than with other correctional operations.