SA Orthopaedic Journal
On-line version ISSN 2309-8309
AIM: To review surgical management and outcome in patients with myelopathy as the presenting complaint due to an underlying spinal deformity. METHODS: A retrospective review of 15 patients over an eight-year period (2002-2009) was performed. The duration and severity of symptoms were recorded, the deformity assessed by radiological measures and surgical management and neurological outcome was reviewed. RESULTS: The average age at surgery was 18.2 years with the average duration of recognised deformity being 60.3 months. Myelopathic symptoms were present for an average of 8 months before surgery with only two patients presenting acutely. Seven patients had congenital spinal deformities, three previous tuberculosis, two neurofibromatosis, one diastrophic dysplasia, one adolescent idiopathic scoliosis and one previously fused myelomeningocoele with pseudarthrosis. Two patients had severe scoliotic curves, three had moderate kyphosis (45-60º), five had severe kyphosis (>90º), and five complicated multi-planar helical deformities. The surgical procedures included one posterior only, two anterior only, five staged anterior and posterior procedures, four combined anterior and posterior procedures and three posteriorly-based circumferential vertebral column resection procedures. Two patients deteriorated neurologically and 13 remained the same or improved: three ASIA B to B/C/D, three C to E, seven D to D/E. Other complications included two aborted anterior procedures due to impossible access, one revision for incomplete decompression, one revision for graft displacement, one deep wound infection and one wound breakdown. CONCLUSION: This heterogeneous group of patients represents an extreme surgical challenge. Once neurological compromise develops, recovery or improvement with surgery is possible, but with associated risk of complete paralysis. However, deterioration is inevitable without surgery. High thoracic deformities are a frequent cause and should be identified and referred early. In this scenario, we currently recommend surgical management by means of a posteriorly based, circumferential decompression and corrective fusion.