Surgical management of paralytic scoliosis in myelomeningocele

A retrospective analysis of 54 patients with paralytic scoliosis due to mye lomeningocele, who underwent surgical treatment, was performed. The aim of this study was to compare different surgical techniques and to identify cli nical parameters influencing primary and midterm results. Three surgical te chniques were used: 1) group I, posterior fusion/instrumentation; 2) group II, anterior fusion/no instrumentation combined with posterior fusion/instr umentation; and 3) group III, anterior and posterior fusion/instrumentation . Average age at surgery was 13.1 years. A preoperative scoliosis angle of 90 degrees [interquartile range (25th-75th percentile) (IQR), 76-106 degree s] was primarily reduced to 38 degrees (IQR, 30-50 degrees). At final follo w-up (mean, 3.3 years), correction deteriorated to 44 degrees (IQR, 38-65 d egrees). The group III procedure resulted in a better midterm correction of scoliosis compared with group I (P = 0.02). The extension of anterior fusi on correlated with primary and midterm correction of scoliosis (P < 0.03). Patients with a thoracic level of paralysis had a higher relative loss of c orrection compared with patients with a lumbar level (P < 0.06). This findi ng can be attributed mostly to group I patients (P = 0.011). Hardware compl ications occurred in 16 patients (30%). Relative loss of correction among t hese patients was high (P < 0.01) and relative midterm correction low (P = 0.001). We recommend anterior and posterior fusion, each with instrumentati on for the treatment of paralytic scoliosis in myelomeningocele. In patient s with a thoracic level of paralysis, the two-stage procedure is mandatory to reduce the risk of hardware complications and subsequent major loss of c orrection.