PMID- 31567706 OWN - NLM STAT- MEDLINE DCOM- 20200622 LR - 20221005 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 478 IP - 1 DP - 2020 Jan TI - Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele? PG - 104-111 LID - 10.1097/CORR.0000000000000976 [doi] AB - BACKGROUND: Lumbar kyphosis is a complex spinal deformity occurring in approximately 8% to 20% of patients with myelomeningocele. The resulting gibbosity may cause pressure ulcers, difficulty lying down in the supine position and sitting on the ischia without support, decreasing quality of life (QOL). Surgery is generally performed to correct kyphosis and maintain vertebral alignment, but high complication rates have been reported. Despite satisfactory radiological results, the impact of surgery and its complications on health-related QOL (HRQOL) has not yet been established. QUESTIONS/PURPOSES: Among children with myelomeningocele undergoing corrective surgery for lumbar kyphosis: (1) What is the risk of complications and reoperation after this procedure? (2) Does this procedure improve HRQOL scores in these patients? METHODS: Between 2012 and 2013, five surgeons at three centers treated 32 patients for myelomeningocele-related kyphosis with kyphectomy and posterior instrumentation. During that period, all surgeons used the same indications for the procedure, which were progressive postural decompensation and chronic ulceration at the apex of the deformity. Data were prospectively collected, and all patients who underwent surgery were considered in this retrospective study. The legal guardians of one patient declined to sign the informed consent form, resulting in 31 patients included. A total of 9.7% (3 of 31) were lost to follow-up before the 2-year period, and the remaining 90.3% (28 of 31) were seen at a mean of 3 years (+/- 9 months) after surgery. The average age was 10 years, 7 months (+/- 21 months) at the time of surgery. The patients had a mean kyphosis angle of 130 degrees +/- 36 degrees before surgery. This technique involved posterior fixation using S-shaped rods inserted through the foramina of S1 and pedicle screws inserted in the thoracic spine. The patients' caregivers answered both the generic and specific (neuromuscular module) Pediatric Quality of Life Inventory questionnaires preoperatively and 2 years postoperatively. The minimum clinically important difference (MCID) considered for the instruments used was 5. RESULTS: Reoperation was performed in 68% of patients (19 of 28), mostly to treat deep infection. In all, 18% of patients (five of 28) underwent implant removal to control infection. Eleven percent (three of 28) had a loss of reduction and pseudarthrosis. The HRQOL increased from 71 +/- 11 preoperatively to 76 +/- 10 postoperatively (p < 0.001), resulting in a 5-point increase (95% CI 3 to 7) in the generic questionnaire score and from 71 +/- 13 to 79 +/- 11 (p < 0.001), resulting in an 8-point increase (95% CI 5 to 10) in the neuromuscular Paediatric Quality of Life Inventory questionnaire score, mainly in the physical health domain on both questionnaires. CONCLUSIONS: Kyphectomy was associated with a high risk of complications and reoperations and did not seem to deliver a substantial clinical benefit for patients who underwent the procedure. Most of our HRQOL score improvements were below the minimum clinically important difference for the Pediatric Quality of Life Inventory questionnaires. Although it seems that surgeons lack a better surgical alternative when facing the challenging health impairments these patients suffer, efforts should be made to improve the technique and reduce surgical complications. Additionally, patients and caregivers should be advised of the high reoperation rate and notified that the procedure may not result in a better QOL and should thus be avoided when possible. Future studies should verify whether decreasing the complication rate could imply improvement in the HRQOL of these patients after surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study. FAU - Petersen, Pedro Araujo AU - Petersen PA AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Marcon, Raphael Martus AU - Marcon RM AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. AD - R. M. Marcon, O. B. Letaif, M. A. Mello Santos, A. F. Cristante, Associacao de Assistencia a Crianca Deficiente, Hospital Abreu Sodre, Sao Paulo, Brazil. FAU - Letaif, Olavo Biraghi AU - Letaif OB AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. AD - R. M. Marcon, O. B. Letaif, M. A. Mello Santos, A. F. Cristante, Associacao de Assistencia a Crianca Deficiente, Hospital Abreu Sodre, Sao Paulo, Brazil. FAU - Mello Santos, Marcus Alexandre AU - Mello Santos MA AD - R. M. Marcon, O. B. Letaif, M. A. Mello Santos, A. F. Cristante, Associacao de Assistencia a Crianca Deficiente, Hospital Abreu Sodre, Sao Paulo, Brazil. FAU - Oliveira, Rafael Garcia AU - Oliveira RG AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Passos de Barros Filho, Tarcisio Eloy AU - Passos de Barros Filho TE AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. FAU - Cristante, Alexandre Fogaca AU - Cristante AF AD - P. A. Petersen, R. M. Marcon, O. B. Letaif, R. G. Oliveira, T. E. Passos de Barros Filho, A. F. Cristante, Spine Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. AD - R. M. Marcon, O. B. Letaif, M. A. Mello Santos, A. F. Cristante, Associacao de Assistencia a Crianca Deficiente, Hospital Abreu Sodre, Sao Paulo, Brazil. LA - eng PT - Journal Article PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM CIN - Clin Orthop Relat Res. 2020 Jan;478(1):112-113. PMID: 31764316 MH - Child MH - Female MH - Humans MH - Kyphosis/etiology/*surgery MH - Lumbar Vertebrae/*surgery MH - Male MH - Meningomyelocele/complications/*surgery MH - Pedicle Screws MH - *Quality of Life MH - Retrospective Studies MH - Spinal Fusion/*instrumentation MH - Treatment Outcome PMC - PMC7000045 COIS- Each author certifies that he has no commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2019/10/01 06:00 MHDA- 2020/06/23 06:00 PMCR- 2021/01/01 CRDT- 2019/10/01 06:00 PHST- 2019/10/01 06:00 [pubmed] PHST- 2020/06/23 06:00 [medline] PHST- 2019/10/01 06:00 [entrez] PHST- 2021/01/01 00:00 [pmc-release] AID - 00003086-202001000-00021 [pii] AID - CORR-D-19-00392 [pii] AID - 10.1097/CORR.0000000000000976 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2020 Jan;478(1):104-111. doi: 10.1097/CORR.0000000000000976.