36 • Probe •Vol LXII • No. 3 • May–Aug 2023 Abstracts From Literature Orthopedics Orthopedic Management of MyelomeningoceleWith a Multidisciplinary Approach Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the health care system. This study reviewed the orthopedic management, outcomes, and complications of patients with MMC undergoing a multidisciplinary approach. PubMed and EMBASE were searched to find relevant studies. All studies that included the clinical management of MMC in patients and that were published earlier than 2000 were considered for review on the condition that they reported at least 1 orthopedic intervention and the rate of complications. However, review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts were excluded. The primary and secondary goals of the review were to report the outcomes and complication rates of the multidisciplinary management of MMC in patients. Twenty-six studies that included data about the management of 229,791 patients with MMC were selected. Sixteen studies reported the multidisciplinary management in addition to orthopedic management. Among those studies, 11 (42.31%) included urological management, 13 (50%) neurosurgical management, 11 (42.31%) neurological management, and 5 (19.23%) gastrointestinal management. Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or nonsurgical, may vary for different patients, given the disease severity and the age of patients. Source: Shobeiri P, et al. J Orthop Surg Res. 2021;16(1):494. Transient Fixation of L4 Vertebra Preserves Lumbar Motion and Function This study investigated the efficacy of a novel surgical method that relies on the transient fixation of L4 in Lenke type 5C and 6C adolescent idiopathic scoliosis. Thirty-six patients whose L4 transient fixation was treated surgically were retrospectively evaluated. The first surgery involved mechanical correction of scoliosis; the lowest instrumented vertebra (LIV) was L4. After an average of 1.3 years (range: 0.3–3.4 y), the second surgery to remove the transient L4 pedicle screws was performed. Radiographic parameters and SRS-22 scores were measured. The Cobb’s angle, coronal balance, LIV tilting angle, and LIV coronal disc angle clearly improved after the first surgery (P < .01). After the second surgery, the corrected Cobb’s angle (P = .446) and coronal balance were maintained (P = .271). Although L3/S1 lumbar lordosis decreased after the first surgery (P < .01), after removal of the transient L4 pedicle screws, it recovered slightly (P = .03). Similarly, the preoperative L3/4 lateral disc mobility eventually recovered after transient L4 screw removal (P < .01). The functional domain of the SRS-22 showed better scores after removal of the transient L4 screws (P = .04). L4 transient fixation surgery is beneficial for Lenke type 5C and 6C scoliosis that do not fully satisfy the LIV (L3) criteria. It preserves L3/4 disc motion, increases functional outcomes, and maintains spinal correction and coronal balance. Source: Yang JH, et al. Sci Rep. 2021;11(1):10192.
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