Surgical treatment of scoliosis in myelomeningocele

The high incidence and rapid progression of scoliosis in myelomeningocele make it one of the most disabling aspects of such disease. The choice of the surgical procedure to treat scoliosis in myelomeningocele is related to the peculiar features of this deformity. The purpose of this study is to review the results obtained by means of various surgical techniques and verify if posterior fusion with pedicle screws can improve results as compared to the single posterior approach. Patients were classified into three groups defined by treatment approach. The single posterior approach following either the Harrington or the Harrington-Luque technique yielded the least satisfactory results. The two-stage anterior-posterior spinal fusion provided good correction and stability. Correction and instrumented fusion through a single posterior approach with segmental fixation by means of pedicle screws proved to be valid and reliable, even when severe deformities had to be corrected and fused. In these latter cases pelvic fixation using ilio-sacral plates also made it possible to correct and stabilize pelvic obliquity.