Early Vertebrectomy (Performed in First 72 Hours after Delivery) as a Treatment Method of Vertebral Column Deformation in Patients with MMC
Authors: Polis Bartosz , Nowoslawska Emilia , Polis Lech 
Published: April 2016

Introduction

8–12% of all dysraphic defects are accompanied by vertebral column deformations like gibbus, that makes a skin closure a very complicated procedure. The presence of lumbar kyphosis in children who suffered from myelomeningocele increases thread of wound dehiscence, large skin necrosis, CNS infections, decubitus ulcer etc. Operative treatment of vertebral column deformations comprise reduction of pathological curvature to: reach a physiological balance of acting forces on vertebral column axis during upright position of a body, reduce a rate of vertebral column kyphosis increasing, minimize a skin tension over a gibbus, increase abdomen cavum capacity and improve breathing 72 hours after delivery is concerned as a critical moment of surgical management, that should not be exceeded. The main goal of the work is to asses efficiency of an early vertebrectomy performed during surgical management of dysraphic defect that makes possible: prevention from mentioned above complications, avoiding further surgical management and spine stabilization in the future.

Material and Methods

In Polish Mother's Memorial Hospital (PMMH) 572 surgical managements of dysraphic defects were performed between year 1992 and 2015. In 89 (15,6%) cases coexistence of pathological spine kyphosis was diagnosed. Myelomeningocele aperta was found to be most common type of DD in our material. All our procedures were performed in first 48 hours after delivery. In 15 cases it was in first 24 hours and in 16 it was in second 24 hours of living. During surgical management of Dysraphic Defect form 1 to 3 vertebral bodied were removed. Spine kyphosis side angle and height were measured. Height of gibbus was measured according to K-C straight and side angle was measured with Cobb-4 method

Results

After such a surgical management we achieve possibility to close skin defect with possible low tension and reduction of pathological spine kyphosis without any foreign material stabilization of the spine. By our surgical management we managed to reduce in average the side angle of the kyphosis by 52,4% and reduce the height in average by 48,06%. Height reduction of pathological spine kyphosis depends on height of pathological spine kyphosis before the surgical management. Side angle quantity of pathological spine kyphosis before the surgical management has statistically significant influence both on height of pathological spine kyphosis and quantity of height reduction after surgical management. Trophic disorders of postoperative wound right after surgery occurred in 12,9% of cases (4 patients) In all catamnesis period it occurred only in 7 cases that was 22,6% of all patients.

Conclusion

Early performed vertebrectomy with gibbus reduction in first 48 hour after delivery allow to: (1) Close dysraphic defect with coexisting large skin loss; (2) Reduce possibility of recurrent postoperative wound trophic disorders; (3) Reduce the growth rate of pathological spine kyphosis during child genesis. The severity of pathological spine kyphosis and occurrence of early postoperative wound trophic defects are predictors in dysraphic patients.