Kyphectomy in children with myelodysplasia - Results 1994-2004

Study Design. We retrospectively studied 24 consecutive pediatric patients with lumbar kyphosis due to myelodysplasia who had received corrective surgical treatment with the Warner and Fackler technique from 1994 to 2004. Objectives. The purpose of the study was to evaluate the technical problems and outcome and to identify complications of this treatment modality, especially regarding the biomechanics. Summary of Background Data. The management of lumbar kyphosis (8%-20%) in conjunction with myelodysplasia is difficult. In 1993, Warner and Fackler presented an elegant surgical technique, which was used here. Methods. Corrective surgery was performed in 24 patients with an average preoperative lumbar kyphosis of 124 degrees. The correction was achieved by kyphectomy combined with stabilization using rods and wires as described by Warner and Fackler. Outcome was rated and complications were identified using data from the clinical records. For biomechanical analysis of the surgical construct, a force model was developed. Results. The mean extent of lumbar kyphosis could be corrected from 124 before surgery to 43 after surgery. Biomechanical analysis showed that inadequate correction results in implant failure. Conclusion. Surgery should always be performed with the intention to reestablish the sagittal profile inasfar as possible so as to reduce the risk of implant failure.