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STUDY DESIGN: Prospective case series. PURPOSE: To describe a new technique for anterior column reconstruction after kyphectomy in myelomeningocele patients using titanium mesh cage and to evaluate outcomes and complications. METHODS: Sixteen patients with severe dorsolumbar kyphosis 2ry to myelomeningocele were enrolled with a mean age of 10.1 years. Kyphectomy procedure and long spinopelvic fixation were done, titanium mesh cage was used to reconstruct the anterior column. Operative time and intraoperative blood loss were calculated. Using the Cobb method, pre and postoperative measurements of local/regional kyphosis were done. Degree and mean percentage of correction were calculated. Anterior intervertebral height of the kyphotic area was also measured. The mean follow-up period was 27 months. RESULTS: Operative time was 271.3 min ± 25, and estimated intraoperative blood loss was 781.3 mL ± 92.3. On average, 2.5 vertebrae were resected. All 16 patients were able to lie supine immediately postoperatively. The mean preoperative local/regional kyphosis was 107.5°, and 106.9° respectively, corrected to 22.5° and 28.8° postoperatively, with a mean degree of correction of 85° and 78.1° respectively. Mean preoperative anterior intervertebral height was 3.54 cm, improved to 4.64 cm postoperatively. Only 2 cases had a superficial wound infection managed conservatively. At the latest follow-up, no loss of correction pseudoarthrosis occurred, and all patients showed solid fusion. CONCLUSION: Titanium mesh cage is an efficient, easy method for anterior reconstruction following kyphectomy in myelomeningocele patients, to maintain postoperative correction. LEVEL OF EVIDENCE: Therapeutic studies, Level IV study.
RESUMO
BACKGROUND: Odontoid process pathologies can cause upper motor neuron lesions. These pathologies can be approached through either a high retropharyngeal approach or a transoral approach. The introduction of the surgical microscope, proper instrumentations, and proper antibiotics has increased utilization of the transoral approach. QUESTIONS/PURPOSES: Our approach to anterior odontoid resection through transoral approach for different pathologies resulting in compression the cervical cord or causing craniocervical instability is described here. We aim to explore the safety and efficacy of this approach. METHODS: Twenty cases of different odontoid pathologies were managed by transoral surgery. Patients were assessed clinically for axial neck pain and radicular symptoms using visual analog scale. The Nurick score was used to get an overall functional evaluation of the difficulty of ambulation and walking. Radiological evaluation of the patients included plain radiographs, CT scans, and MRI of the cervical spine. Posterior surgery was done as a first stage for restoring the sagittal profile of the cervical spine. Transoral surgery was done as a second stage for odontoid resection and anterior decompression of the cord. RESULTS: Average follow-up was 29.4 ± 3.8 months. Mean preoperative Nurick scale was 1.3 ± 1.2. Mean postoperative Nurcik scale was 0.5 ± 0.61. Patients with axial neck pain were improved after surgery except the 6 patients; mean VAS preoperative 8.2 ± 2.3 SD, mean postoperative VAS 3.7 ± 0.8SD, and radicular symptoms were not significantly changed after surgery; gait changes were improved in all patients with preoperative gait disturbance. CONCLUSION: The transoral approach is a safe and effective surgical method for the direct decompression of ventral midline extradural compressive disease of the craniovertebral junction.
