Kyphectomy for Myelodysplasia

A progressive kyphotic deformity occurs in 15% of children with myelomingocele. The more common problems caused by the gibbus are recurrent or recalcitrant skin ulceration and seating difficulties. The only effective treatment is surgery. Excellent correction is possible by vertebrectomy of a portion of the cephalad limb of the deformity. Superior maintenance of the correction is accomplished by segmental spinal instrumentation. Alternative techniques that spare growth are currently being investigated. Vertebral body decancellation is one such method that is less extensive than vertebrectomy and, theoreticallty, allows continued spinal growth. It seems most appropriate for the younger patient with a less rigid and dramatic deformity.