Kyphectomy for severe kyphosis with pyogenic spondylitis associated with myelomeningocele

Description: A 32-year-old woman was referred to our hospital for a refractory ulcer in her back. She had a history of myelomeningocele with spina bifida that was treated surgically at birth. The ulcer was located at the apex of the kyphosis. An X-ray film revealed a kyphosis of 154 between L1 and 3 and scoliosis of 60 between T11 and L5. Computed tomography and magnetic resonance imaging examinations and laboratory data indicated the presence of pyogenic spondylitis at L2/3. To correct the kyphosis and remove the infected vertebrae together with the skin ulcer, kyphectomy was performed. Pedicle screws were inserted from T8 to T12 and from L4 to S1. The dural sac was transected and ligated at L2, followed by total kyphectomy of the L1-L3 vertebrae. Then, the spinal column was reconstructed by approximating the ventral wall of the T12 vertebral body and the cranial endplate of the L4 vertebra. Postoperatively, the kyphosis was corrected to 61o and the scoliosis was corrected to 22 degrees. In the present case, we treated the skin ulcer and pyogenic spondylitis successfully by kyphectomy, thereby, preventing recurrence of the ulcer and infection, and simultaneously obtaining sufficient correction of the spinal deformity.
Kyphectomy for severe kyphosis with pyogenic spondylitis associated with myelomeningocele: a case report Kenji Yoshioka , Kota Watanabe , Yoshiaki Toyama , Kazuhiro Chiba and Morio Matsumoto Scoliosis 2011, 6:5