Latalski Michal MD, Fatyga Marek MD 23/04/12 “Eiffel Tower” Construction In Gradual Correction Of Children With Congenital Kyphosis In Myelomeningocele - Till 7 Years Follow Up. Latalski Michal MD, Fatyga Marek MD Children Orthopedic Department Medical University Lublin, Poland 1

conflict of interest disclosure 23/04/12 conflict of interest disclosure There is no conflict of interest for any author. 2

myelomeningocoele Increasing rigid hyperkyphosis; decubitus; 23/04/12 myelomeningocoele 11 y.o. girl Increasing rigid hyperkyphosis; decubitus; Impossible supine position; Huge final operation After 1 year

„Eiffel Tower” configuration Double „rib – pelvis” construct 23/04/12 „Eiffel Tower” configuration Double „rib – pelvis” construct Distractions every 6-10 months Aim: protect from TIS decrease spine deformation

Material 7 children - 2 males and 5 females Age: 5-9 y.o. 23/04/12 Material 7 children - 2 males and 5 females Age: 5-9 y.o. Deformation before IP: 90-160° (mean 115 °) Primary correction: 40°-145° (mean 72°) Follow up: 1-7 y-s (mean 4 y-s) five patients further correction after distractions two patient initial correction was maintained

23/04/12 Case 1 boy 4 y.o. 77° 90° sitting supine

23/04/12 45° F-up 6 years No hump Better function No progresion

23/04/12 Case 2 girl 8 y.o. 160° 135° Elongation test

Reversion to primary deformation 21% 23/04/12 135 F-up 6 years Still presence of hump Better function Reversion to primary deformation 21%

Case 3 girl 4 y.o. 135° 95° F-up 2 years Smaller hump Better function 23/04/12 135° 95° Case 3 girl 4 y.o. F-up 2 years Smaller hump Better function No progresion

23/04/12 Discusion Hardware protects from the progression of deformation during spine growth Although correction wasn’t spectacular, it was associated with functional improvement The younger children/smaller/flexible deformation- the better correction After spine maturity SF is necessary- some patients probably can avoid kyphectomy

23/04/12 Conclusion This treatment seems to be an alternative only for younger patients without severe structural changes in vertebral bodies and with flexible deformation to stop further progresion.