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J Am Acad Orthop Surg, Vol 14, No 5, May 2006, 294-302.
© 2006 the American Academy of Orthopaedic Surgeons
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Congenital and Developmental Deformities of the Spine in Children With Myelomeningocele

James T. Guille, MD, John F. Sarwark, MD, Henry H. Sherk, MD and S. Jay Kumar, MD

Dr. Guille is Orthopaedic Surgeon, Shriners Hospital for Children, Philadelphia, PA. Dr. Sarwark is Chairman, Department of Orthopaedic Surgery, The Children’s Memorial Hospital, Chicago, IL, and Professor of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago. Dr. Sherk is Professor, Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia. Dr. Kumar is Director, Spinal Dysfunction Clinic, Alfred I. duPont Hospital for Children, Wilmington, DE, and Clinical Professor of Orthopaedic Surgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Guille, Dr. Sarwark, Dr. Sherk, and Dr. Kumar.

Reprint requests: Dr. Guille, Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140.

The treatment of spinal deformities in children with myelomeningocele poses a formidable task. Multiple medical comorbidities, such as insensate skin and chronic urinary tract infection, make care of the spine difficult. A thorough understanding of the natural history of these deformities is mandatory for appropriate treatment to be rendered. A team approach that includes physicians from multiple specialties provides the best care for these patients. The two most challenging problems are paralytic scoliosis and rigid lumbar kyphosis. The precise indications for surgical intervention are multifactorial, and the proposed benefits must be weighed against the potential risks. Newer spinal constructs now allow for fixation of the spine in areas previously difficult to instrument. Complications appear to be decreasing with improved understanding of the pathophysiology associated with myelomeningocele.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.